| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,007 |
1,989 |
$572K |
| D1206 |
Topical application of fluoride varnish |
16,990 |
16,771 |
$348K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,110 |
1,053 |
$336K |
| D0120 |
Periodic oral evaluation - established patient |
14,188 |
14,081 |
$324K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,057 |
3,352 |
$312K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
224 |
221 |
$275K |
| D1120 |
Prophylaxis - child |
9,901 |
9,849 |
$271K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,592 |
6,270 |
$242K |
| D1110 |
Prophylaxis - adult |
5,341 |
5,309 |
$208K |
| D1351 |
Sealant - per tooth |
6,076 |
1,137 |
$186K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,118 |
1,304 |
$125K |
| D0272 |
Bitewings - two radiographic images |
6,259 |
6,202 |
$117K |
| D2140 |
|
2,053 |
1,585 |
$99K |
| D0274 |
Bitewings - four radiographic images |
2,448 |
2,432 |
$77K |
| D2933 |
|
364 |
123 |
$64K |
| D1330 |
|
11,488 |
11,399 |
$62K |
| D0603 |
|
5,334 |
5,309 |
$53K |
| D0330 |
Panoramic radiographic image |
1,035 |
1,029 |
$44K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
607 |
333 |
$38K |
| D8660 |
|
174 |
174 |
$36K |
| D9920 |
|
785 |
772 |
$35K |
| D1310 |
|
5,760 |
5,675 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,157 |
1,146 |
$26K |
| D9248 |
|
204 |
201 |
$24K |
| D2160 |
|
358 |
299 |
$24K |
| D0602 |
|
2,290 |
2,278 |
$23K |
| D8680 |
|
120 |
117 |
$19K |
| D0601 |
|
1,741 |
1,736 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,808 |
1,783 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
218 |
216 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
418 |
415 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
720 |
643 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
124 |
92 |
$8K |
| D2331 |
|
129 |
92 |
$8K |
| D2330 |
|
61 |
45 |
$3K |
| D0240 |
|
77 |
71 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$736.03 |
| D9110 |
|
12 |
12 |
$412.87 |
| D1999 |
|
46 |
44 |
$0.00 |