| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
8,207 |
7,313 |
$574K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
680 |
171 |
$106K |
| D1120 |
Prophylaxis - child |
1,596 |
1,533 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
2,142 |
2,069 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,453 |
1,400 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,956 |
1,872 |
$33K |
| D1110 |
Prophylaxis - adult |
1,026 |
992 |
$33K |
| D9420 |
|
165 |
154 |
$29K |
| D1351 |
Sealant - per tooth |
580 |
154 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
124 |
40 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
182 |
70 |
$10K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
15 |
13 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
268 |
223 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
149 |
141 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
12 |
$3K |
| D8660 |
|
26 |
26 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
46 |
12 |
$2K |
| D2330 |
|
21 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
158 |
151 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$975.50 |
| D0272 |
Bitewings - two radiographic images |
42 |
38 |
$783.47 |
| D0240 |
|
32 |
30 |
$424.18 |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
26 |
$398.78 |
| D9215 |
|
372 |
209 |
$0.00 |