| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
6,812 |
6,517 |
$1.63M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,025 |
7,710 |
$1.61M |
| D1120 |
Prophylaxis - child |
28,284 |
26,996 |
$1.40M |
| D0120 |
Periodic oral evaluation - established patient |
41,983 |
39,900 |
$1.13M |
| D1110 |
Prophylaxis - adult |
17,456 |
16,495 |
$1.03M |
| D1206 |
Topical application of fluoride varnish |
39,241 |
37,420 |
$986K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,315 |
5,746 |
$841K |
| D7240 |
Removal of impacted tooth - completely bony |
2,405 |
671 |
$777K |
| D0274 |
Bitewings - four radiographic images |
15,472 |
14,478 |
$592K |
| D1351 |
Sealant - per tooth |
11,415 |
3,586 |
$445K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
390 |
364 |
$434K |
| D0272 |
Bitewings - two radiographic images |
13,762 |
13,072 |
$395K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,793 |
1,779 |
$307K |
| D2740 |
Crown - porcelain/ceramic |
530 |
321 |
$306K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,600 |
722 |
$298K |
| D0140 |
Limited oral evaluation - problem focused |
6,157 |
5,721 |
$248K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,165 |
1,216 |
$213K |
| D0330 |
Panoramic radiographic image |
3,568 |
3,416 |
$213K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,185 |
1,324 |
$199K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,968 |
2,826 |
$142K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,410 |
5,666 |
$126K |
| D8660 |
|
2,989 |
2,955 |
$95K |
| D2950 |
|
610 |
385 |
$89K |
| D8680 |
|
806 |
764 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
4,053 |
3,712 |
$70K |
| D3120 |
|
1,812 |
935 |
$62K |
| D2394 |
|
388 |
254 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
737 |
703 |
$49K |
| D2335 |
|
248 |
154 |
$42K |
| D1354 |
|
2,827 |
469 |
$41K |
| D8690 |
|
269 |
266 |
$35K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
391 |
200 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,236 |
1,694 |
$29K |
| D9310 |
|
515 |
478 |
$27K |
| D2160 |
|
187 |
159 |
$20K |
| D9110 |
|
238 |
215 |
$15K |
| D7230 |
|
29 |
12 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
12 |
$4K |
| D0270 |
|
220 |
218 |
$3K |
| D2140 |
|
36 |
26 |
$3K |
| D2332 |
|
15 |
13 |
$2K |
| D2330 |
|
23 |
13 |
$2K |
| D7111 |
|
20 |
13 |
$2K |
| D1999 |
|
6,883 |
5,993 |
$0.00 |
| D0602 |
|
672 |
665 |
$0.00 |
| D0603 |
|
7,145 |
7,029 |
$0.00 |
| D0601 |
|
14 |
14 |
$0.00 |