| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,933 |
23,787 |
$776K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,280 |
27,098 |
$508K |
| D0120 |
Periodic oral evaluation - established patient |
17,110 |
16,962 |
$400K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,818 |
822 |
$335K |
| D7240 |
Removal of impacted tooth - completely bony |
1,368 |
454 |
$257K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,154 |
7,154 |
$255K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,201 |
2,017 |
$233K |
| D0272 |
Bitewings - two radiographic images |
9,404 |
9,356 |
$197K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,085 |
5,809 |
$166K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,640 |
502 |
$134K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,287 |
1,511 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
10,297 |
10,190 |
$120K |
| D0274 |
Bitewings - four radiographic images |
3,736 |
3,721 |
$113K |
| D2934 |
|
685 |
201 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,026 |
8,881 |
$90K |
| D9243 |
|
649 |
543 |
$88K |
| D1351 |
Sealant - per tooth |
3,378 |
1,084 |
$82K |
| D9239 |
|
556 |
554 |
$67K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
17 |
17 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
841 |
541 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,633 |
1,621 |
$49K |
| D1110 |
Prophylaxis - adult |
987 |
980 |
$39K |
| D7230 |
|
245 |
112 |
$38K |
| D0240 |
|
2,522 |
1,710 |
$37K |
| D8660 |
|
332 |
332 |
$35K |
| D9420 |
|
394 |
393 |
$29K |
| D0330 |
Panoramic radiographic image |
330 |
328 |
$17K |
| D2929 |
|
139 |
40 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
316 |
288 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
138 |
56 |
$15K |
| D9610 |
|
486 |
486 |
$12K |
| D9248 |
|
171 |
171 |
$4K |
| D2331 |
|
23 |
14 |
$2K |
| D2332 |
|
16 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
13 |
$1K |