| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
12,784 |
12,184 |
$1.26M |
| D1120 |
Prophylaxis - child |
38,245 |
34,728 |
$1.05M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,576 |
6,936 |
$1.02M |
| D1351 |
Sealant - per tooth |
41,734 |
10,204 |
$1.01M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,605 |
6,749 |
$790K |
| D0120 |
Periodic oral evaluation - established patient |
25,056 |
23,029 |
$647K |
| D1206 |
Topical application of fluoride varnish |
25,419 |
23,068 |
$578K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
596 |
532 |
$558K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,919 |
12,543 |
$507K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,853 |
1,394 |
$411K |
| D0330 |
Panoramic radiographic image |
8,514 |
7,806 |
$358K |
| D0274 |
Bitewings - four radiographic images |
13,622 |
12,573 |
$323K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,286 |
11,574 |
$300K |
| D0272 |
Bitewings - two radiographic images |
17,266 |
15,683 |
$288K |
| D0220 |
Intraoral - periapical first radiographic image |
19,706 |
17,773 |
$215K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,718 |
11,735 |
$201K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,867 |
13,285 |
$182K |
| D7240 |
Removal of impacted tooth - completely bony |
545 |
131 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
884 |
847 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,015 |
678 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
588 |
414 |
$58K |
| D1110 |
Prophylaxis - adult |
3,701 |
3,304 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
977 |
906 |
$35K |
| D0340 |
|
516 |
495 |
$24K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
273 |
206 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
378 |
173 |
$21K |
| D9222 |
|
271 |
218 |
$16K |
| D0350 |
|
341 |
314 |
$8K |
| D2330 |
|
91 |
55 |
$4K |
| D2332 |
|
24 |
14 |
$792.16 |
| D0270 |
|
62 |
54 |
$293.69 |
| D7111 |
|
43 |
29 |
$0.00 |
| D4346 |
|
16 |
13 |
$0.00 |
| D1999 |
|
2,088 |
1,903 |
$0.00 |
| D0180 |
|
15 |
15 |
$0.00 |