| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
10,468 |
4,528 |
$1.82M |
| D8670 |
Periodic orthodontic treatment visit |
7,106 |
6,471 |
$1.61M |
| D1120 |
Prophylaxis - child |
16,869 |
16,565 |
$854K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,960 |
2,083 |
$783K |
| D2332 |
|
5,630 |
2,999 |
$761K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,686 |
3,169 |
$579K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,987 |
3,139 |
$565K |
| D1206 |
Topical application of fluoride varnish |
19,963 |
19,592 |
$520K |
| D1351 |
Sealant - per tooth |
12,770 |
4,073 |
$504K |
| D0120 |
Periodic oral evaluation - established patient |
14,861 |
14,563 |
$429K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,069 |
2,384 |
$398K |
| D9110 |
|
3,786 |
3,657 |
$273K |
| D1110 |
Prophylaxis - adult |
3,454 |
3,366 |
$231K |
| D2394 |
|
1,330 |
1,063 |
$224K |
| D2160 |
|
2,130 |
1,299 |
$222K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,977 |
1,223 |
$203K |
| D1516 |
|
626 |
604 |
$203K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,417 |
3,332 |
$195K |
| D1517 |
|
576 |
558 |
$189K |
| D0272 |
Bitewings - two radiographic images |
6,006 |
5,902 |
$175K |
| D0274 |
Bitewings - four radiographic images |
3,888 |
3,805 |
$165K |
| D1515 |
|
463 |
375 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,478 |
956 |
$132K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
110 |
106 |
$128K |
| D0330 |
Panoramic radiographic image |
1,893 |
1,859 |
$118K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,629 |
5,299 |
$115K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,225 |
725 |
$111K |
| D2161 |
|
662 |
524 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
2,702 |
2,562 |
$51K |
| D8680 |
|
469 |
364 |
$40K |
| D2330 |
|
412 |
295 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
729 |
704 |
$34K |
| D8690 |
|
192 |
187 |
$24K |
| D9310 |
|
409 |
376 |
$23K |
| D2140 |
|
290 |
184 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,456 |
531 |
$16K |
| D8660 |
|
346 |
343 |
$16K |
| D3120 |
|
180 |
133 |
$7K |
| D2331 |
|
28 |
13 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
365 |
342 |
$0.00 |
| D1999 |
|
518 |
487 |
$0.00 |