| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
28,862 |
23,407 |
$2.15M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27,864 |
13,366 |
$1.92M |
| D1120 |
Prophylaxis - child |
90,587 |
66,898 |
$1.73M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26,203 |
12,092 |
$1.25M |
| D0120 |
Periodic oral evaluation - established patient |
47,292 |
41,821 |
$1.00M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,615 |
3,044 |
$974K |
| D1351 |
Sealant - per tooth |
50,362 |
12,366 |
$966K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44,317 |
25,702 |
$885K |
| D1206 |
Topical application of fluoride varnish |
44,958 |
34,964 |
$757K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26,551 |
20,628 |
$541K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,318 |
881 |
$530K |
| D0210 |
Intraoral - complete series of radiographic images |
13,431 |
8,364 |
$470K |
| D1208 |
Topical application of fluoride, excluding varnish |
42,365 |
29,577 |
$417K |
| D0274 |
Bitewings - four radiographic images |
30,590 |
22,737 |
$400K |
| D0272 |
Bitewings - two radiographic images |
41,800 |
31,369 |
$386K |
| D0330 |
Panoramic radiographic image |
22,631 |
16,321 |
$341K |
| D0220 |
Intraoral - periapical first radiographic image |
39,207 |
30,401 |
$285K |
| D7240 |
Removal of impacted tooth - completely bony |
1,836 |
437 |
$256K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,673 |
22,458 |
$207K |
| D0140 |
Limited oral evaluation - problem focused |
5,138 |
3,959 |
$144K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,230 |
846 |
$138K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,531 |
558 |
$121K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,781 |
1,047 |
$113K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,077 |
344 |
$64K |
| D2934 |
|
466 |
81 |
$42K |
| D9222 |
|
585 |
451 |
$36K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
502 |
402 |
$31K |
| D0350 |
|
1,580 |
1,216 |
$28K |
| D0340 |
|
735 |
654 |
$28K |
| D7230 |
|
113 |
25 |
$7K |
| D1110 |
Prophylaxis - adult |
1,402 |
913 |
$5K |
| D2330 |
|
69 |
43 |
$5K |
| D1999 |
|
14,600 |
11,823 |
$0.00 |
| D0470 |
|
13 |
13 |
$0.00 |