| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
5,561 |
5,220 |
$1.29M |
| D1110 |
Prophylaxis - adult |
14,032 |
13,348 |
$779K |
| D1120 |
Prophylaxis - child |
13,586 |
13,095 |
$657K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,266 |
4,249 |
$638K |
| D0120 |
Periodic oral evaluation - established patient |
23,891 |
22,927 |
$607K |
| D1206 |
Topical application of fluoride varnish |
18,867 |
18,237 |
$472K |
| D0274 |
Bitewings - four radiographic images |
8,396 |
8,071 |
$297K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,601 |
2,313 |
$244K |
| D7240 |
Removal of impacted tooth - completely bony |
736 |
164 |
$197K |
| D0210 |
Intraoral - complete series of radiographic images |
2,926 |
2,722 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,375 |
4,126 |
$188K |
| D1351 |
Sealant - per tooth |
4,118 |
1,143 |
$164K |
| D0140 |
Limited oral evaluation - problem focused |
4,082 |
3,812 |
$156K |
| D0330 |
Panoramic radiographic image |
2,531 |
2,427 |
$134K |
| D0272 |
Bitewings - two radiographic images |
4,992 |
4,842 |
$134K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
97 |
92 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,080 |
767 |
$101K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
971 |
555 |
$82K |
| D8660 |
|
1,694 |
1,685 |
$55K |
| D2740 |
Crown - porcelain/ceramic |
79 |
60 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,472 |
2,070 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
324 |
178 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
461 |
293 |
$40K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
205 |
140 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,318 |
2,192 |
$34K |
| D9310 |
|
642 |
455 |
$21K |
| D8680 |
|
203 |
187 |
$17K |
| D4341 |
|
63 |
26 |
$8K |
| D8690 |
|
40 |
40 |
$5K |
| D2140 |
|
66 |
51 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
42 |
36 |
$4K |
| D3120 |
|
74 |
37 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
222 |
169 |
$2K |
| D2332 |
|
16 |
13 |
$2K |
| D1354 |
|
63 |
15 |
$945.00 |
| D2330 |
|
19 |
12 |
$560.00 |
| D0180 |
|
13 |
12 |
$491.00 |
| D0270 |
|
26 |
26 |
$320.00 |
| D1999 |
|
3,856 |
3,455 |
$0.00 |
| D0601 |
|
71 |
71 |
$0.00 |
| D0602 |
|
1,077 |
1,069 |
$0.00 |
| D0603 |
|
3,192 |
3,156 |
$0.00 |