| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,293 |
1,291 |
$287K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
586 |
576 |
$134K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,956 |
588 |
$119K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
71 |
71 |
$69K |
| D9222 |
|
580 |
574 |
$65K |
| D1110 |
Prophylaxis - adult |
1,435 |
1,425 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,922 |
1,891 |
$49K |
| D0330 |
Panoramic radiographic image |
1,312 |
1,289 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,524 |
1,512 |
$42K |
| D8660 |
|
413 |
413 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,388 |
1,380 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
552 |
370 |
$33K |
| D7240 |
Removal of impacted tooth - completely bony |
117 |
50 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
208 |
146 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
186 |
75 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
270 |
262 |
$11K |
| D7230 |
|
81 |
48 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
204 |
126 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
241 |
237 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,013 |
987 |
$8K |
| D8680 |
|
67 |
67 |
$8K |
| D1120 |
Prophylaxis - child |
237 |
237 |
$7K |
| D9110 |
|
208 |
204 |
$7K |
| D1351 |
Sealant - per tooth |
264 |
39 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
552 |
541 |
$5K |
| D1206 |
Topical application of fluoride varnish |
267 |
267 |
$5K |
| D2332 |
|
73 |
49 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
120 |
114 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
253 |
252 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
31 |
17 |
$3K |
| D2335 |
|
45 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
128 |
128 |
$2K |
| D1330 |
|
376 |
376 |
$935.00 |
| D0603 |
|
130 |
130 |
$590.00 |
| D0601 |
|
62 |
62 |
$430.00 |
| D1310 |
|
118 |
118 |
$30.00 |
| D1999 |
|
740 |
674 |
$0.00 |