| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
3,309 |
2,600 |
$7.20M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
49,694 |
10,495 |
$3.26M |
| D1206 |
Topical application of fluoride varnish |
58,297 |
56,389 |
$2.56M |
| D1120 |
Prophylaxis - child |
41,392 |
40,098 |
$2.03M |
| D1351 |
Sealant - per tooth |
87,621 |
18,525 |
$2.01M |
| D0120 |
Periodic oral evaluation - established patient |
37,490 |
36,374 |
$1.46M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39,451 |
38,151 |
$1.38M |
| D0330 |
Panoramic radiographic image |
43,423 |
38,247 |
$1.20M |
| D0210 |
Intraoral - complete series of radiographic images |
22,302 |
21,638 |
$1.16M |
| D8660 |
|
29,853 |
26,928 |
$1.14M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,757 |
9,316 |
$1.05M |
| D8020 |
|
944 |
676 |
$914K |
| D9310 |
|
18,273 |
17,441 |
$894K |
| D7140 |
Extraction, erupted tooth or exposed root |
18,696 |
6,285 |
$793K |
| D0230 |
Intraoral - periapical each additional radiographic image |
110,395 |
55,489 |
$703K |
| D0220 |
Intraoral - periapical first radiographic image |
45,868 |
43,955 |
$671K |
| D7240 |
Removal of impacted tooth - completely bony |
4,549 |
2,192 |
$614K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,948 |
2,605 |
$611K |
| D0274 |
Bitewings - four radiographic images |
26,462 |
25,437 |
$598K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
11,825 |
8,301 |
$587K |
| D7220 |
|
4,488 |
2,212 |
$488K |
| D1110 |
Prophylaxis - adult |
10,726 |
10,464 |
$454K |
| D9222 |
|
8,959 |
8,438 |
$439K |
| D0140 |
Limited oral evaluation - problem focused |
12,245 |
11,586 |
$400K |
| D0272 |
Bitewings - two radiographic images |
16,659 |
16,312 |
$304K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,682 |
3,968 |
$276K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,960 |
13,132 |
$247K |
| D7310 |
|
3,242 |
1,115 |
$226K |
| D0340 |
|
6,699 |
5,400 |
$213K |
| D7230 |
|
1,888 |
1,266 |
$211K |
| D2740 |
Crown - porcelain/ceramic |
562 |
375 |
$209K |
| D0350 |
|
14,763 |
12,712 |
$189K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,478 |
2,473 |
$137K |
| D1353 |
|
8,372 |
2,240 |
$130K |
| D0470 |
|
6,704 |
5,370 |
$129K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,828 |
1,146 |
$109K |
| D7311 |
|
825 |
441 |
$57K |
| D2950 |
|
524 |
336 |
$41K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,266 |
1,266 |
$39K |
| D9248 |
|
409 |
396 |
$37K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
606 |
217 |
$33K |
| D9612 |
|
1,226 |
1,132 |
$31K |
| D2929 |
|
198 |
56 |
$25K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
71 |
65 |
$22K |
| D9420 |
|
550 |
521 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,059 |
1,058 |
$21K |
| D4346 |
|
467 |
416 |
$19K |
| D0190 |
|
23,547 |
20,963 |
$17K |
| D0270 |
|
1,666 |
1,529 |
$16K |
| D0603 |
|
8,890 |
8,735 |
$8K |
| D3230 |
|
69 |
25 |
$7K |
| D3120 |
|
364 |
195 |
$7K |
| D0602 |
|
5,518 |
5,328 |
$5K |
| D2330 |
|
42 |
28 |
$2K |
| D1354 |
|
214 |
65 |
$2K |
| D2335 |
|
21 |
13 |
$2K |
| D0601 |
|
1,975 |
1,839 |
$2K |
| D5899 |
|
112 |
49 |
$2K |
| D2332 |
|
17 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
12 |
$1K |
| D7510 |
|
15 |
14 |
$1K |
| D0240 |
|
31 |
30 |
$749.42 |
| D0160 |
|
13 |
13 |
$325.00 |
| D9951 |
|
12 |
12 |
$139.94 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$133.12 |
| D1999 |
|
23,624 |
21,348 |
$0.00 |