| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
4,538 |
4,482 |
$1.20M |
| D1120 |
Prophylaxis - child |
20,601 |
20,536 |
$1.08M |
| D1208 |
Topical application of fluoride, excluding varnish |
28,188 |
28,097 |
$824K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,754 |
3,902 |
$800K |
| D0120 |
Periodic oral evaluation - established patient |
23,649 |
23,585 |
$703K |
| D0140 |
Limited oral evaluation - problem focused |
13,064 |
12,958 |
$631K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,904 |
1,292 |
$591K |
| D1110 |
Prophylaxis - adult |
6,063 |
6,046 |
$430K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,637 |
739 |
$386K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,703 |
2,139 |
$378K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,990 |
2,418 |
$376K |
| D0274 |
Bitewings - four radiographic images |
4,988 |
4,971 |
$220K |
| D0330 |
Panoramic radiographic image |
2,368 |
2,364 |
$212K |
| D0272 |
Bitewings - two radiographic images |
6,755 |
6,738 |
$208K |
| D0220 |
Intraoral - periapical first radiographic image |
8,730 |
8,500 |
$177K |
| D1351 |
Sealant - per tooth |
4,014 |
1,469 |
$165K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,659 |
2,655 |
$157K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,452 |
816 |
$137K |
| D9110 |
|
1,795 |
1,769 |
$132K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,948 |
4,950 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,991 |
5,656 |
$125K |
| D8680 |
|
902 |
890 |
$89K |
| D9222 |
|
564 |
562 |
$61K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
49 |
49 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
420 |
320 |
$54K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
428 |
215 |
$45K |
| D8660 |
|
452 |
447 |
$32K |
| D8690 |
|
227 |
224 |
$30K |
| D9310 |
|
470 |
458 |
$29K |
| D2330 |
|
185 |
73 |
$17K |
| D2140 |
|
87 |
53 |
$7K |
| D2950 |
|
32 |
26 |
$6K |
| D3120 |
|
106 |
75 |
$4K |
| D1206 |
Topical application of fluoride varnish |
119 |
119 |
$3K |
| D9920 |
|
24 |
24 |
$2K |
| D9941 |
|
13 |
13 |
$1K |