| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,302 |
3,270 |
$830K |
| D1120 |
Prophylaxis - child |
15,093 |
15,042 |
$786K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,255 |
3,593 |
$654K |
| D0120 |
Periodic oral evaluation - established patient |
19,546 |
19,451 |
$568K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,776 |
1,240 |
$558K |
| D1351 |
Sealant - per tooth |
13,627 |
4,666 |
$555K |
| D1206 |
Topical application of fluoride varnish |
20,755 |
20,666 |
$551K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,367 |
3,771 |
$539K |
| D1110 |
Prophylaxis - adult |
7,391 |
7,365 |
$495K |
| D0274 |
Bitewings - four radiographic images |
7,854 |
7,833 |
$331K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,527 |
916 |
$217K |
| D0272 |
Bitewings - two radiographic images |
6,854 |
6,835 |
$208K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,842 |
3,822 |
$192K |
| D0220 |
Intraoral - periapical first radiographic image |
10,361 |
10,136 |
$190K |
| D0330 |
Panoramic radiographic image |
4,879 |
4,849 |
$187K |
| D0140 |
Limited oral evaluation - problem focused |
3,934 |
3,845 |
$160K |
| D7111 |
|
1,611 |
902 |
$125K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
891 |
653 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,661 |
5,004 |
$96K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
85 |
82 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
857 |
535 |
$81K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,871 |
1,672 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
451 |
449 |
$29K |
| D2740 |
Crown - porcelain/ceramic |
39 |
26 |
$28K |
| D9945 |
|
103 |
96 |
$28K |
| D8680 |
|
161 |
154 |
$14K |
| D8690 |
|
84 |
84 |
$11K |
| D2330 |
|
129 |
66 |
$11K |
| D8660 |
|
59 |
59 |
$8K |
| D5212 |
|
13 |
13 |
$7K |
| D5211 |
|
12 |
12 |
$6K |
| D9941 |
|
85 |
69 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
54 |
38 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
138 |
137 |
$4K |
| D2140 |
|
50 |
39 |
$4K |
| D2335 |
|
16 |
12 |
$2K |
| D1999 |
|
4,236 |
3,583 |
$0.00 |