| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
14,487 |
13,712 |
$1.48M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,959 |
1,824 |
$608K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,210 |
6,153 |
$491K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,417 |
4,826 |
$468K |
| D1351 |
Sealant - per tooth |
24,950 |
7,574 |
$433K |
| D1120 |
Prophylaxis - child |
15,521 |
14,826 |
$370K |
| D1206 |
Topical application of fluoride varnish |
27,319 |
25,813 |
$366K |
| D1110 |
Prophylaxis - adult |
10,934 |
10,610 |
$340K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,190 |
5,079 |
$338K |
| D0120 |
Periodic oral evaluation - established patient |
16,472 |
15,664 |
$276K |
| D0210 |
Intraoral - complete series of radiographic images |
5,037 |
4,825 |
$243K |
| D0330 |
Panoramic radiographic image |
5,626 |
5,345 |
$242K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,203 |
1,399 |
$219K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
184 |
176 |
$177K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,199 |
6,904 |
$172K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,365 |
2,030 |
$171K |
| D2394 |
|
1,904 |
1,634 |
$159K |
| D0140 |
Limited oral evaluation - problem focused |
7,128 |
6,800 |
$153K |
| D2331 |
|
2,080 |
1,613 |
$111K |
| D0272 |
Bitewings - two radiographic images |
7,180 |
6,709 |
$102K |
| D0274 |
Bitewings - four radiographic images |
5,111 |
4,785 |
$98K |
| D2330 |
|
1,709 |
1,217 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
7,575 |
7,262 |
$66K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
692 |
472 |
$64K |
| D3320 |
|
241 |
222 |
$56K |
| D0191 |
|
4,776 |
4,645 |
$50K |
| D3310 |
|
264 |
210 |
$48K |
| D8660 |
|
486 |
455 |
$33K |
| D0470 |
|
885 |
835 |
$32K |
| D2335 |
|
415 |
309 |
$30K |
| D2332 |
|
434 |
343 |
$30K |
| D5110 |
|
54 |
53 |
$29K |
| D9110 |
|
896 |
850 |
$23K |
| D8020 |
|
26 |
26 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
863 |
734 |
$13K |
| D4342 |
|
349 |
202 |
$12K |
| D0999 |
Unspecified diagnostic procedure, by report |
825 |
820 |
$9K |
| D1354 |
|
912 |
334 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
696 |
559 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
57 |
50 |
$2K |
| D4910 |
|
26 |
26 |
$1K |
| D0270 |
|
94 |
82 |
$595.24 |