| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
6,720 |
5,658 |
$646K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,701 |
2,143 |
$461K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,646 |
1,175 |
$461K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,014 |
2,175 |
$375K |
| D1120 |
Prophylaxis - child |
11,507 |
10,105 |
$317K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,097 |
1,712 |
$299K |
| D0120 |
Periodic oral evaluation - established patient |
8,909 |
8,384 |
$242K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,760 |
8,695 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,552 |
3,612 |
$138K |
| D0272 |
Bitewings - two radiographic images |
6,259 |
5,426 |
$109K |
| D0330 |
Panoramic radiographic image |
2,771 |
2,356 |
$107K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,463 |
2,482 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
1,939 |
1,720 |
$73K |
| D9248 |
|
692 |
649 |
$33K |
| D1510 |
|
140 |
102 |
$27K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
250 |
148 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,694 |
1,511 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,240 |
875 |
$21K |
| D1351 |
Sealant - per tooth |
566 |
222 |
$15K |
| D1110 |
Prophylaxis - adult |
429 |
395 |
$9K |
| D0274 |
Bitewings - four radiographic images |
245 |
235 |
$8K |
| D2390 |
|
57 |
14 |
$8K |
| D2330 |
|
90 |
50 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
26 |
$421.38 |