| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
14,893 |
14,361 |
$6.42M |
| D1120 |
Prophylaxis - child |
175,933 |
175,531 |
$5.81M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69,106 |
43,137 |
$5.05M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55,256 |
36,487 |
$4.84M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
3,536 |
3,536 |
$3.67M |
| D1206 |
Topical application of fluoride varnish |
168,341 |
167,981 |
$3.45M |
| D0120 |
Periodic oral evaluation - established patient |
163,409 |
163,077 |
$3.25M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23,181 |
10,540 |
$3.14M |
| D1110 |
Prophylaxis - adult |
60,269 |
60,122 |
$2.79M |
| D1351 |
Sealant - per tooth |
75,236 |
26,458 |
$2.40M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
79,836 |
79,560 |
$2.33M |
| D7240 |
Removal of impacted tooth - completely bony |
9,500 |
3,304 |
$2.26M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
60,317 |
57,088 |
$2.00M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14,651 |
7,137 |
$1.64M |
| D7140 |
Extraction, erupted tooth or exposed root |
25,113 |
14,640 |
$1.62M |
| D0272 |
Bitewings - two radiographic images |
71,721 |
71,541 |
$1.42M |
| D1208 |
Topical application of fluoride, excluding varnish |
64,875 |
64,676 |
$1.33M |
| D8660 |
|
6,630 |
6,627 |
$1.27M |
| D0210 |
Intraoral - complete series of radiographic images |
29,034 |
28,466 |
$1.11M |
| D0274 |
Bitewings - four radiographic images |
40,053 |
39,957 |
$1.09M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,541 |
1,365 |
$1.02M |
| D0220 |
Intraoral - periapical first radiographic image |
93,161 |
92,321 |
$1.01M |
| D0230 |
Intraoral - periapical each additional radiographic image |
68,465 |
61,371 |
$752K |
| D0140 |
Limited oral evaluation - problem focused |
33,984 |
33,546 |
$680K |
| D0330 |
Panoramic radiographic image |
15,338 |
15,240 |
$653K |
| D2934 |
|
3,097 |
1,122 |
$550K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,635 |
3,092 |
$548K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,034 |
2,240 |
$343K |
| D7230 |
|
1,528 |
954 |
$302K |
| D2950 |
|
2,091 |
1,706 |
$225K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,162 |
537 |
$134K |
| D7250 |
|
985 |
492 |
$123K |
| D2330 |
|
1,081 |
646 |
$79K |
| D3320 |
|
142 |
107 |
$58K |
| D7111 |
|
1,999 |
1,452 |
$37K |
| D2140 |
|
547 |
264 |
$32K |
| D9222 |
|
406 |
406 |
$25K |
| D2332 |
|
198 |
126 |
$23K |
| D7220 |
|
140 |
106 |
$20K |
| D3120 |
|
899 |
572 |
$17K |
| D9920 |
|
204 |
190 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
166 |
125 |
$12K |
| D0270 |
|
707 |
696 |
$8K |
| D8680 |
|
12 |
12 |
$5K |
| D2331 |
|
42 |
36 |
$4K |
| D0340 |
|
38 |
38 |
$3K |
| D1510 |
|
14 |
12 |
$2K |