| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,311 |
23,959 |
$1.02M |
| D1351 |
Sealant - per tooth |
33,824 |
8,310 |
$819K |
| D1206 |
Topical application of fluoride varnish |
25,745 |
25,339 |
$676K |
| D0120 |
Periodic oral evaluation - established patient |
21,613 |
21,345 |
$566K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,193 |
4,436 |
$565K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,064 |
3,288 |
$291K |
| D8670 |
Periodic orthodontic treatment visit |
4,657 |
4,386 |
$233K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,013 |
9,369 |
$182K |
| D0330 |
Panoramic radiographic image |
3,392 |
3,330 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,215 |
13,513 |
$94K |
| D1110 |
Prophylaxis - adult |
2,170 |
2,143 |
$87K |
| D0603 |
|
11,458 |
11,276 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
15,337 |
14,942 |
$74K |
| D7240 |
Removal of impacted tooth - completely bony |
414 |
79 |
$71K |
| D0272 |
Bitewings - two radiographic images |
8,571 |
8,481 |
$70K |
| D9310 |
|
6,126 |
5,872 |
$67K |
| D9920 |
|
3,842 |
3,616 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,186 |
2,164 |
$55K |
| D0274 |
Bitewings - four radiographic images |
4,182 |
4,136 |
$52K |
| D8680 |
|
39 |
38 |
$43K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
40 |
39 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
967 |
942 |
$24K |
| D0340 |
|
1,723 |
1,681 |
$22K |
| D0602 |
|
1,960 |
1,957 |
$19K |
| D0601 |
|
1,828 |
1,809 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
253 |
172 |
$14K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
321 |
88 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
58 |
44 |
$6K |
| D9222 |
|
90 |
79 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
299 |
291 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
13 |
$4K |
| D0350 |
|
2,176 |
2,116 |
$2K |
| D0270 |
|
359 |
353 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
25 |
$2K |
| D7111 |
|
14 |
12 |
$495.00 |
| D1354 |
|
53 |
12 |
$265.00 |
| D8660 |
|
1,183 |
1,154 |
$0.00 |