| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,783 |
3,734 |
$941K |
| D1120 |
Prophylaxis - child |
17,779 |
17,704 |
$923K |
| D0120 |
Periodic oral evaluation - established patient |
23,436 |
23,339 |
$677K |
| D1110 |
Prophylaxis - adult |
9,463 |
9,416 |
$624K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,872 |
3,961 |
$613K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,272 |
4,714 |
$607K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,536 |
1,336 |
$511K |
| D1351 |
Sealant - per tooth |
11,267 |
3,893 |
$467K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,613 |
13,585 |
$404K |
| D0274 |
Bitewings - four radiographic images |
7,647 |
7,614 |
$320K |
| D1206 |
Topical application of fluoride varnish |
10,743 |
10,675 |
$285K |
| D2740 |
Crown - porcelain/ceramic |
349 |
167 |
$241K |
| D0272 |
Bitewings - two radiographic images |
8,019 |
7,976 |
$240K |
| D0330 |
Panoramic radiographic image |
5,460 |
5,430 |
$232K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,751 |
3,737 |
$190K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,304 |
850 |
$189K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
149 |
149 |
$178K |
| D0140 |
Limited oral evaluation - problem focused |
4,099 |
4,022 |
$169K |
| D0220 |
Intraoral - periapical first radiographic image |
8,659 |
8,474 |
$158K |
| D7111 |
|
1,859 |
1,157 |
$145K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,417 |
812 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,506 |
4,298 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
862 |
858 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
444 |
357 |
$48K |
| D2950 |
|
303 |
174 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,192 |
2,021 |
$45K |
| D7240 |
Removal of impacted tooth - completely bony |
124 |
43 |
$42K |
| D3120 |
|
687 |
473 |
$25K |
| D8680 |
|
260 |
243 |
$25K |
| D0270 |
|
1,695 |
1,653 |
$22K |
| D8690 |
|
137 |
135 |
$17K |
| D8660 |
|
118 |
118 |
$15K |
| D2140 |
|
203 |
161 |
$15K |
| D2335 |
|
19 |
12 |
$2K |
| D2330 |
|
21 |
14 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$1K |
| D1999 |
|
4,851 |
4,192 |
$0.00 |