| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
6,117 |
5,768 |
$1.42M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,379 |
6,496 |
$1.11M |
| D1120 |
Prophylaxis - child |
19,733 |
18,696 |
$951K |
| D1110 |
Prophylaxis - adult |
14,123 |
13,317 |
$788K |
| D0120 |
Periodic oral evaluation - established patient |
28,871 |
27,363 |
$755K |
| D1206 |
Topical application of fluoride varnish |
25,138 |
23,870 |
$631K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,351 |
4,426 |
$530K |
| D0274 |
Bitewings - four radiographic images |
13,250 |
12,478 |
$493K |
| D1351 |
Sealant - per tooth |
12,834 |
4,019 |
$486K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
307 |
299 |
$369K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,366 |
5,866 |
$281K |
| D0140 |
Limited oral evaluation - problem focused |
6,954 |
6,438 |
$271K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,463 |
1,681 |
$239K |
| D0330 |
Panoramic radiographic image |
4,364 |
4,050 |
$226K |
| D0272 |
Bitewings - two radiographic images |
7,755 |
7,363 |
$218K |
| D0210 |
Intraoral - complete series of radiographic images |
3,347 |
3,080 |
$215K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
869 |
563 |
$159K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,784 |
1,067 |
$158K |
| D2740 |
Crown - porcelain/ceramic |
216 |
154 |
$149K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,610 |
994 |
$139K |
| D0220 |
Intraoral - periapical first radiographic image |
6,668 |
6,143 |
$103K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,172 |
4,447 |
$96K |
| D7240 |
Removal of impacted tooth - completely bony |
282 |
75 |
$88K |
| D4342 |
|
1,083 |
435 |
$84K |
| D8660 |
|
1,909 |
1,897 |
$79K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
111 |
101 |
$75K |
| D2950 |
|
368 |
284 |
$55K |
| D9310 |
|
1,143 |
897 |
$51K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
334 |
225 |
$45K |
| D3120 |
|
1,170 |
818 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
239 |
166 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,463 |
1,044 |
$16K |
| D0240 |
|
667 |
576 |
$13K |
| D8680 |
|
121 |
115 |
$11K |
| D0270 |
|
815 |
733 |
$9K |
| D8690 |
|
61 |
60 |
$8K |
| D2140 |
|
111 |
85 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
161 |
161 |
$4K |
| D7111 |
|
46 |
38 |
$4K |
| D4341 |
|
23 |
12 |
$3K |
| D1510 |
|
15 |
12 |
$3K |
| D8999 |
|
54 |
52 |
$2K |
| D2332 |
|
20 |
12 |
$2K |
| D2330 |
|
35 |
17 |
$2K |
| D2335 |
|
14 |
12 |
$2K |
| D4346 |
|
40 |
30 |
$2K |
| D2331 |
|
12 |
12 |
$1K |
| D0180 |
|
26 |
26 |
$988.00 |
| D1999 |
|
5,326 |
4,765 |
$0.00 |
| D0602 |
|
451 |
442 |
$0.00 |
| D0601 |
|
278 |
274 |
$0.00 |
| D0603 |
|
2,860 |
2,808 |
$0.00 |