| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,257 |
3,252 |
$931K |
| D0120 |
Periodic oral evaluation - established patient |
16,413 |
16,370 |
$921K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,626 |
1,163 |
$773K |
| D1120 |
Prophylaxis - child |
17,120 |
17,076 |
$663K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,424 |
2,858 |
$642K |
| D4341 |
|
7,999 |
2,253 |
$549K |
| D0230 |
Intraoral - periapical each additional radiographic image |
122,856 |
23,592 |
$493K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,875 |
6,863 |
$426K |
| D4910 |
|
4,287 |
4,274 |
$329K |
| D1110 |
Prophylaxis - adult |
3,196 |
3,190 |
$275K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,672 |
21,618 |
$274K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
568 |
534 |
$261K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,703 |
2,290 |
$247K |
| D9430 |
|
7,365 |
7,220 |
$232K |
| D0210 |
Intraoral - complete series of radiographic images |
4,653 |
4,641 |
$218K |
| D0350 |
|
23,387 |
8,096 |
$216K |
| D0274 |
Bitewings - four radiographic images |
10,201 |
10,161 |
$215K |
| D1351 |
Sealant - per tooth |
8,303 |
2,056 |
$214K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,675 |
1,510 |
$179K |
| D2954 |
|
1,330 |
1,003 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,525 |
1,606 |
$136K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,091 |
2,986 |
$122K |
| D4342 |
|
2,682 |
883 |
$112K |
| D0330 |
Panoramic radiographic image |
3,648 |
3,639 |
$105K |
| D1310 |
|
2,276 |
2,268 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
9,460 |
9,317 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,432 |
839 |
$82K |
| D9993 |
|
969 |
967 |
$59K |
| D0272 |
Bitewings - two radiographic images |
4,753 |
4,746 |
$56K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
424 |
263 |
$49K |
| D2140 |
|
882 |
551 |
$47K |
| D3320 |
|
122 |
112 |
$45K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
423 |
256 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
430 |
336 |
$34K |
| D2160 |
|
406 |
277 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
837 |
837 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
349 |
349 |
$19K |
| D0603 |
|
745 |
734 |
$11K |
| D2330 |
|
138 |
94 |
$10K |
| D7230 |
|
49 |
29 |
$9K |
| D0602 |
|
593 |
585 |
$9K |
| D3310 |
|
24 |
17 |
$7K |
| D0470 |
|
302 |
302 |
$7K |
| D0340 |
|
135 |
134 |
$7K |
| D3221 |
|
71 |
58 |
$4K |
| D2331 |
|
22 |
12 |
$2K |
| D0270 |
|
30 |
30 |
$140.00 |