| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
13,901 |
12,243 |
$2.27M |
| D8670 |
Periodic orthodontic treatment visit |
1,373 |
1,372 |
$290K |
| D0120 |
Periodic oral evaluation - established patient |
9,293 |
7,702 |
$134K |
| D1110 |
Prophylaxis - adult |
3,309 |
3,217 |
$15K |
| D0340 |
|
310 |
310 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,203 |
1,939 |
$11K |
| D8660 |
|
385 |
385 |
$11K |
| D0470 |
|
363 |
363 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,863 |
1,578 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
774 |
772 |
$5K |
| D0350 |
|
403 |
403 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,182 |
2,120 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,137 |
1,715 |
$3K |
| D0330 |
Panoramic radiographic image |
1,185 |
1,183 |
$2K |
| D2331 |
|
475 |
358 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
966 |
879 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
945 |
577 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
1,986 |
1,938 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,919 |
1,756 |
$2K |
| D0274 |
Bitewings - four radiographic images |
2,234 |
2,222 |
$2K |
| D9310 |
|
1,368 |
1,361 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,974 |
1,972 |
$2K |
| D1120 |
Prophylaxis - child |
3,931 |
3,929 |
$2K |
| D1351 |
Sealant - per tooth |
1,448 |
696 |
$1K |
| D5110 |
|
77 |
53 |
$988.72 |
| D2740 |
Crown - porcelain/ceramic |
69 |
52 |
$955.33 |
| D4341 |
|
337 |
157 |
$772.48 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
106 |
100 |
$725.70 |
| D1208 |
Topical application of fluoride, excluding varnish |
3,199 |
3,196 |
$717.08 |
| D1206 |
Topical application of fluoride varnish |
2,243 |
2,241 |
$649.05 |
| D0272 |
Bitewings - two radiographic images |
2,289 |
2,286 |
$555.08 |
| D2330 |
|
258 |
193 |
$527.24 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
126 |
94 |
$477.36 |
| D0191 |
|
15 |
14 |
$348.65 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
173 |
153 |
$287.56 |
| D0270 |
|
29 |
28 |
$0.00 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
46 |
41 |
$0.00 |
| D4342 |
|
44 |
26 |
$0.00 |
| D0240 |
|
52 |
52 |
$0.00 |
| D7111 |
|
299 |
282 |
$0.00 |
| D5214 |
|
13 |
12 |
$0.00 |
| D9995 |
|
13 |
12 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
35 |
32 |
$0.00 |