| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
2,813 |
2,785 |
$3.18M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,413 |
1,816 |
$1.09M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,483 |
2,450 |
$449K |
| D1354 |
|
10,752 |
3,239 |
$446K |
| D1120 |
Prophylaxis - child |
14,067 |
13,884 |
$401K |
| D1206 |
Topical application of fluoride varnish |
21,452 |
21,179 |
$327K |
| D0120 |
Periodic oral evaluation - established patient |
16,063 |
15,854 |
$319K |
| D1110 |
Prophylaxis - adult |
7,194 |
7,101 |
$306K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,150 |
2,241 |
$237K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,508 |
1,643 |
$224K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,953 |
7,702 |
$206K |
| D1351 |
Sealant - per tooth |
8,714 |
2,947 |
$198K |
| D0330 |
Panoramic radiographic image |
4,097 |
4,061 |
$187K |
| D2934 |
|
1,204 |
330 |
$150K |
| D0274 |
Bitewings - four radiographic images |
5,289 |
5,224 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,190 |
4,129 |
$120K |
| D7111 |
|
1,678 |
994 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
752 |
417 |
$95K |
| D0603 |
|
10,661 |
10,529 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
6,449 |
6,269 |
$92K |
| D3120 |
|
3,118 |
1,463 |
$89K |
| D0272 |
Bitewings - two radiographic images |
4,759 |
4,703 |
$81K |
| D3110 |
|
2,053 |
810 |
$77K |
| D7961 |
|
395 |
348 |
$71K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
808 |
292 |
$69K |
| D0340 |
|
1,147 |
1,136 |
$65K |
| D9310 |
|
1,084 |
1,080 |
$49K |
| D9248 |
|
359 |
351 |
$48K |
| D0240 |
|
2,229 |
1,319 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,326 |
1,317 |
$38K |
| D7960 |
|
206 |
162 |
$36K |
| D0470 |
|
957 |
946 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,756 |
2,601 |
$34K |
| D0602 |
|
1,543 |
1,543 |
$13K |
| D0350 |
|
332 |
332 |
$9K |
| D2335 |
|
66 |
28 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
219 |
219 |
$6K |
| D7962 |
|
27 |
27 |
$6K |
| D1510 |
|
22 |
14 |
$3K |
| D2330 |
|
24 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
36 |
36 |
$493.34 |