| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
6,002 |
5,728 |
$1.44M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,716 |
8,465 |
$1.31M |
| D1120 |
Prophylaxis - child |
25,622 |
24,678 |
$1.28M |
| D1110 |
Prophylaxis - adult |
19,022 |
18,338 |
$1.10M |
| D0120 |
Periodic oral evaluation - established patient |
39,775 |
38,347 |
$1.06M |
| D1206 |
Topical application of fluoride varnish |
33,762 |
32,593 |
$867K |
| D7240 |
Removal of impacted tooth - completely bony |
2,316 |
644 |
$736K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,578 |
5,872 |
$693K |
| D0274 |
Bitewings - four radiographic images |
13,506 |
13,045 |
$513K |
| D1351 |
Sealant - per tooth |
12,036 |
3,738 |
$487K |
| D0140 |
Limited oral evaluation - problem focused |
8,700 |
8,114 |
$345K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
276 |
267 |
$320K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,858 |
6,496 |
$314K |
| D0272 |
Bitewings - two radiographic images |
10,548 |
10,278 |
$309K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,883 |
2,220 |
$286K |
| D0330 |
Panoramic radiographic image |
4,866 |
4,596 |
$263K |
| D0210 |
Intraoral - complete series of radiographic images |
3,148 |
2,953 |
$208K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,526 |
5,773 |
$127K |
| D2740 |
Crown - porcelain/ceramic |
182 |
139 |
$120K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,342 |
852 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
6,863 |
6,434 |
$108K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
735 |
357 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,170 |
701 |
$96K |
| D8660 |
|
2,736 |
2,686 |
$88K |
| D8690 |
|
408 |
402 |
$53K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
211 |
142 |
$40K |
| D8680 |
|
349 |
315 |
$30K |
| D9310 |
|
564 |
471 |
$24K |
| D2950 |
|
62 |
52 |
$10K |
| D2335 |
|
50 |
37 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
668 |
450 |
$7K |
| D4342 |
|
74 |
32 |
$6K |
| D3120 |
|
108 |
82 |
$4K |
| D2332 |
|
16 |
12 |
$2K |
| D0603 |
|
8,315 |
8,257 |
$0.00 |
| D1999 |
|
7,783 |
6,913 |
$0.00 |