| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
5,011 |
4,518 |
$261K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,430 |
1,858 |
$255K |
| D0120 |
Periodic oral evaluation - established patient |
10,319 |
10,182 |
$213K |
| D1120 |
Prophylaxis - child |
8,046 |
7,927 |
$209K |
| D1110 |
Prophylaxis - adult |
4,821 |
4,774 |
$202K |
| D1351 |
Sealant - per tooth |
10,262 |
1,854 |
$192K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
392 |
314 |
$179K |
| D0210 |
Intraoral - complete series of radiographic images |
2,117 |
2,108 |
$114K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,937 |
6,893 |
$103K |
| D2954 |
|
764 |
614 |
$97K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,055 |
443 |
$84K |
| D0274 |
Bitewings - four radiographic images |
3,767 |
3,643 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
7,344 |
7,098 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,109 |
2,085 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
2,529 |
2,423 |
$49K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
88 |
83 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
498 |
347 |
$43K |
| D0272 |
Bitewings - two radiographic images |
3,090 |
2,985 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,668 |
2,412 |
$35K |
| D2740 |
Crown - porcelain/ceramic |
63 |
42 |
$33K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
308 |
183 |
$30K |
| D1353 |
|
2,751 |
435 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,522 |
4,416 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
342 |
244 |
$19K |
| D9310 |
|
734 |
726 |
$16K |
| D0330 |
Panoramic radiographic image |
627 |
615 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,478 |
1,438 |
$12K |
| D7111 |
|
183 |
116 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
153 |
88 |
$9K |
| D0602 |
|
404 |
404 |
$4K |
| D2332 |
|
39 |
26 |
$3K |
| D4910 |
|
34 |
34 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
13 |
$1K |
| D9920 |
|
60 |
58 |
$967.00 |
| D0601 |
|
87 |
87 |
$870.00 |
| D8660 |
|
12 |
12 |
$457.00 |
| D0240 |
|
79 |
29 |
$400.68 |
| D0350 |
|
96 |
95 |
$85.00 |