| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
8,656 |
7,752 |
$1.73M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,806 |
2,913 |
$1.07M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,386 |
1,347 |
$1.05M |
| D1351 |
Sealant - per tooth |
20,773 |
4,785 |
$902K |
| D0120 |
Periodic oral evaluation - established patient |
21,097 |
20,072 |
$853K |
| D1120 |
Prophylaxis - child |
15,285 |
14,606 |
$807K |
| D1206 |
Topical application of fluoride varnish |
23,893 |
22,840 |
$753K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,442 |
2,441 |
$641K |
| D1110 |
Prophylaxis - adult |
8,769 |
8,424 |
$622K |
| D8090 |
|
221 |
204 |
$431K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
320 |
295 |
$426K |
| D0274 |
Bitewings - four radiographic images |
7,686 |
7,360 |
$389K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,449 |
6,661 |
$294K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,913 |
703 |
$283K |
| D8020 |
|
121 |
115 |
$279K |
| D0240 |
|
9,891 |
4,198 |
$253K |
| D8660 |
|
709 |
668 |
$227K |
| D0330 |
Panoramic radiographic image |
2,671 |
2,544 |
$224K |
| D0220 |
Intraoral - periapical first radiographic image |
7,985 |
7,507 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,289 |
2,759 |
$176K |
| D0210 |
Intraoral - complete series of radiographic images |
1,687 |
1,621 |
$166K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,545 |
1,355 |
$101K |
| D0140 |
Limited oral evaluation - problem focused |
1,283 |
1,225 |
$78K |
| D0272 |
Bitewings - two radiographic images |
2,127 |
2,026 |
$76K |
| D1354 |
|
2,033 |
643 |
$60K |
| D0160 |
|
540 |
420 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
158 |
119 |
$50K |
| D0170 |
|
855 |
792 |
$45K |
| D9920 |
|
339 |
325 |
$45K |
| D2330 |
|
39 |
32 |
$7K |
| D2331 |
|
17 |
13 |
$4K |
| D9222 |
|
15 |
15 |
$4K |
| D0350 |
|
282 |
236 |
$3K |
| D9219 |
|
698 |
644 |
$0.00 |
| D9986 |
|
1,542 |
1,408 |
$0.00 |
| D1999 |
|
3,846 |
3,378 |
$0.00 |
| D0340 |
|
42 |
42 |
$0.00 |
| D0603 |
|
17,530 |
16,271 |
$0.00 |
| D0602 |
|
8,783 |
8,314 |
$0.00 |
| D9630 |
|
218 |
203 |
$0.00 |
| D0601 |
|
88 |
77 |
$0.00 |
| D9310 |
|
630 |
607 |
$0.00 |