| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,623 |
3,262 |
$1.09M |
| D7140 |
Extraction, erupted tooth or exposed root |
13,141 |
6,371 |
$960K |
| D1206 |
Topical application of fluoride varnish |
8,604 |
8,057 |
$474K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
519 |
508 |
$313K |
| D1110 |
Prophylaxis - adult |
7,784 |
7,577 |
$296K |
| D0140 |
Limited oral evaluation - problem focused |
20,022 |
19,677 |
$264K |
| D0120 |
Periodic oral evaluation - established patient |
8,799 |
8,398 |
$259K |
| D1120 |
Prophylaxis - child |
8,937 |
8,287 |
$222K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,717 |
6,397 |
$213K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,306 |
1,263 |
$177K |
| D9310 |
|
3,252 |
3,139 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,251 |
1,673 |
$172K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,929 |
1,552 |
$168K |
| D0210 |
Intraoral - complete series of radiographic images |
2,579 |
2,531 |
$151K |
| D0330 |
Panoramic radiographic image |
4,464 |
4,329 |
$149K |
| D0220 |
Intraoral - periapical first radiographic image |
14,033 |
13,734 |
$125K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,043 |
2,926 |
$116K |
| D1351 |
Sealant - per tooth |
2,211 |
848 |
$111K |
| D9222 |
|
598 |
586 |
$87K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
518 |
431 |
$59K |
| D0270 |
|
6,010 |
5,926 |
$45K |
| D0272 |
Bitewings - two radiographic images |
3,829 |
3,611 |
$43K |
| D3348 |
|
29 |
29 |
$22K |
| D0340 |
|
300 |
294 |
$21K |
| D9110 |
|
629 |
601 |
$15K |
| D0364 |
|
34 |
33 |
$13K |
| D4341 |
|
131 |
83 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,364 |
1,065 |
$10K |
| D0274 |
Bitewings - four radiographic images |
476 |
463 |
$10K |
| D2752 |
|
14 |
13 |
$10K |
| D0470 |
|
281 |
273 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
56 |
$6K |
| D2331 |
|
53 |
43 |
$6K |
| D9239 |
|
39 |
39 |
$5K |
| D7240 |
Removal of impacted tooth - completely bony |
21 |
12 |
$5K |
| D4355 |
|
277 |
258 |
$5K |
| D0240 |
|
234 |
232 |
$3K |
| D7230 |
|
16 |
13 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
100 |
100 |
$3K |
| D9995 |
|
288 |
284 |
$3K |
| D0191 |
|
156 |
153 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
24 |
13 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
28 |
13 |
$2K |
| D9248 |
|
14 |
12 |
$2K |
| D4342 |
|
21 |
16 |
$1K |
| D4910 |
|
12 |
12 |
$1K |
| D0350 |
|
327 |
320 |
$1K |
| D2940 |
|
50 |
43 |
$970.20 |
| D9243 |
|
15 |
13 |
$509.95 |
| D9951 |
|
30 |
28 |
$378.00 |
| D0603 |
|
21 |
21 |
$0.00 |
| D1999 |
|
20 |
19 |
$0.00 |
| D9430 |
|
25 |
12 |
$0.00 |