| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,240 |
919 |
$340K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,193 |
2,214 |
$289K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,873 |
426 |
$283K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,251 |
2,016 |
$245K |
| D0120 |
Periodic oral evaluation - established patient |
8,575 |
8,462 |
$231K |
| D1120 |
Prophylaxis - child |
9,044 |
8,903 |
$208K |
| D8670 |
Periodic orthodontic treatment visit |
719 |
701 |
$156K |
| D1206 |
Topical application of fluoride varnish |
7,312 |
7,205 |
$145K |
| D1351 |
Sealant - per tooth |
5,275 |
1,379 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,603 |
2,549 |
$94K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,860 |
3,624 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
10,098 |
9,807 |
$81K |
| D0160 |
|
2,237 |
2,011 |
$80K |
| D1110 |
Prophylaxis - adult |
2,075 |
2,045 |
$80K |
| D8030 |
|
392 |
271 |
$73K |
| D7240 |
Removal of impacted tooth - completely bony |
524 |
175 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,372 |
3,316 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,219 |
9,440 |
$60K |
| D0272 |
Bitewings - two radiographic images |
6,232 |
6,115 |
$59K |
| D9630 |
|
1,347 |
1,319 |
$58K |
| D0330 |
Panoramic radiographic image |
2,506 |
2,303 |
$57K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,925 |
1,914 |
$54K |
| D8660 |
|
223 |
151 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,301 |
1,263 |
$26K |
| D1999 |
|
1,632 |
1,443 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
305 |
162 |
$17K |
| D9248 |
|
214 |
211 |
$13K |
| D7230 |
|
91 |
43 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
96 |
$10K |
| D2390 |
|
32 |
12 |
$9K |
| D0274 |
Bitewings - four radiographic images |
249 |
241 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
22 |
13 |
$3K |
| D7111 |
|
68 |
40 |
$2K |
| D0170 |
|
27 |
26 |
$880.00 |
| D8999 |
|
17 |
17 |
$0.00 |
| D1330 |
|
122 |
118 |
$0.00 |