| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,659 |
1,415 |
$519K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,594 |
3,298 |
$414K |
| D0120 |
Periodic oral evaluation - established patient |
14,851 |
14,354 |
$362K |
| D1206 |
Topical application of fluoride varnish |
18,551 |
17,728 |
$320K |
| D1351 |
Sealant - per tooth |
14,024 |
2,886 |
$295K |
| D1120 |
Prophylaxis - child |
13,355 |
12,757 |
$270K |
| D8670 |
Periodic orthodontic treatment visit |
1,590 |
1,412 |
$214K |
| D1110 |
Prophylaxis - adult |
4,843 |
4,683 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,452 |
3,193 |
$117K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,913 |
876 |
$101K |
| D0272 |
Bitewings - two radiographic images |
10,714 |
10,275 |
$100K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
646 |
152 |
$98K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,170 |
709 |
$86K |
| D0330 |
Panoramic radiographic image |
2,607 |
2,438 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,603 |
934 |
$76K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,664 |
2,547 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
2,881 |
2,699 |
$60K |
| D0160 |
|
1,675 |
1,579 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
6,278 |
5,994 |
$48K |
| D1999 |
|
4,743 |
4,066 |
$46K |
| D0240 |
|
6,589 |
3,134 |
$45K |
| D9630 |
|
958 |
849 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,709 |
1,456 |
$34K |
| D0274 |
Bitewings - four radiographic images |
2,948 |
2,845 |
$30K |
| D7240 |
Removal of impacted tooth - completely bony |
128 |
44 |
$21K |
| D9920 |
|
737 |
676 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,432 |
5,586 |
$18K |
| D9992 |
|
1,123 |
1,074 |
$15K |
| D0340 |
|
179 |
160 |
$9K |
| D0170 |
|
309 |
288 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
84 |
37 |
$9K |
| D7230 |
|
31 |
12 |
$3K |
| D2332 |
|
36 |
25 |
$3K |
| D9110 |
|
65 |
65 |
$3K |
| D1330 |
|
1,563 |
1,495 |
$0.00 |
| D9310 |
|
93 |
92 |
$0.00 |