| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
4,052 |
4,028 |
$502K |
| D1120 |
Prophylaxis - child |
11,254 |
11,248 |
$402K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,209 |
1,810 |
$378K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,302 |
2,202 |
$326K |
| D1351 |
Sealant - per tooth |
6,087 |
2,291 |
$264K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,117 |
8,108 |
$170K |
| D1206 |
Topical application of fluoride varnish |
6,404 |
6,402 |
$165K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,763 |
10,635 |
$146K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,689 |
1,680 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
5,073 |
5,072 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
11,542 |
11,517 |
$116K |
| D0330 |
Panoramic radiographic image |
3,799 |
3,799 |
$106K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,100 |
785 |
$90K |
| D0272 |
Bitewings - two radiographic images |
5,672 |
5,670 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,059 |
5,053 |
$61K |
| D0340 |
|
1,513 |
1,510 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,456 |
1,373 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
366 |
254 |
$30K |
| D9310 |
|
681 |
681 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
2,102 |
2,093 |
$23K |
| D0470 |
|
793 |
791 |
$20K |
| D1510 |
|
201 |
159 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
764 |
764 |
$20K |
| D0350 |
|
1,672 |
1,670 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
1,169 |
1,167 |
$14K |
| D9243 |
|
118 |
118 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
245 |
167 |
$11K |
| D9239 |
|
106 |
106 |
$6K |
| D0274 |
Bitewings - four radiographic images |
248 |
248 |
$6K |
| D1354 |
|
210 |
64 |
$4K |
| D1110 |
Prophylaxis - adult |
67 |
67 |
$3K |
| D2330 |
|
38 |
24 |
$2K |
| D1330 |
|
203 |
202 |
$0.00 |
| D1310 |
|
13 |
13 |
$0.00 |