| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
6,366 |
1,632 |
$1.90M |
| D1120 |
Prophylaxis - child |
32,327 |
31,122 |
$1.60M |
| D1110 |
Prophylaxis - adult |
23,355 |
22,386 |
$1.40M |
| D0120 |
Periodic oral evaluation - established patient |
48,926 |
46,826 |
$1.32M |
| D1206 |
Topical application of fluoride varnish |
44,506 |
42,812 |
$1.13M |
| D1351 |
Sealant - per tooth |
28,236 |
7,050 |
$1.10M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,761 |
5,783 |
$831K |
| D8670 |
Periodic orthodontic treatment visit |
2,657 |
2,518 |
$626K |
| D0274 |
Bitewings - four radiographic images |
14,009 |
13,470 |
$543K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,818 |
4,700 |
$539K |
| D0330 |
Panoramic radiographic image |
8,186 |
7,546 |
$495K |
| D0140 |
Limited oral evaluation - problem focused |
12,232 |
11,026 |
$477K |
| D0272 |
Bitewings - two radiographic images |
12,142 |
11,700 |
$350K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,291 |
6,909 |
$349K |
| D0210 |
Intraoral - complete series of radiographic images |
4,128 |
3,858 |
$289K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,141 |
800 |
$269K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
198 |
192 |
$227K |
| D2740 |
Crown - porcelain/ceramic |
280 |
207 |
$185K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,517 |
6,703 |
$139K |
| D0220 |
Intraoral - periapical first radiographic image |
8,131 |
7,672 |
$135K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
634 |
394 |
$123K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,065 |
818 |
$106K |
| D7230 |
|
411 |
187 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,074 |
742 |
$90K |
| D2950 |
|
499 |
393 |
$76K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
638 |
420 |
$56K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
81 |
65 |
$47K |
| D8680 |
|
369 |
354 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,343 |
1,034 |
$16K |
| D8660 |
|
512 |
503 |
$14K |
| D8690 |
|
93 |
93 |
$11K |
| D7111 |
|
113 |
75 |
$9K |
| D4341 |
|
59 |
25 |
$7K |
| D2330 |
|
60 |
38 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
185 |
173 |
$4K |
| D2140 |
|
51 |
39 |
$4K |
| D0270 |
|
267 |
245 |
$4K |
| D2331 |
|
33 |
24 |
$3K |
| D2332 |
|
24 |
13 |
$3K |
| D0180 |
|
32 |
31 |
$1K |
| D8999 |
|
13 |
12 |
$648.00 |
| D1354 |
|
23 |
16 |
$210.00 |
| D0603 |
|
5,603 |
5,510 |
$0.00 |
| D1999 |
|
8,143 |
7,766 |
$0.00 |