| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
4,670 |
4,616 |
$1.19M |
| D1120 |
Prophylaxis - child |
15,653 |
15,427 |
$796K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,138 |
4,623 |
$726K |
| D1351 |
Sealant - per tooth |
17,520 |
6,043 |
$714K |
| D0120 |
Periodic oral evaluation - established patient |
21,818 |
21,468 |
$617K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,089 |
4,764 |
$580K |
| D1110 |
Prophylaxis - adult |
9,062 |
8,907 |
$575K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,868 |
1,447 |
$567K |
| D1206 |
Topical application of fluoride varnish |
21,636 |
21,272 |
$557K |
| D0274 |
Bitewings - four radiographic images |
10,791 |
10,605 |
$437K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
308 |
305 |
$356K |
| D0272 |
Bitewings - two radiographic images |
8,993 |
8,869 |
$266K |
| D0330 |
Panoramic radiographic image |
5,228 |
5,121 |
$198K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,815 |
1,343 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,740 |
3,669 |
$179K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,710 |
1,155 |
$166K |
| D0220 |
Intraoral - periapical first radiographic image |
8,481 |
8,227 |
$154K |
| D0140 |
Limited oral evaluation - problem focused |
3,140 |
3,041 |
$132K |
| D7111 |
|
1,289 |
855 |
$98K |
| D8690 |
|
763 |
761 |
$97K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
547 |
380 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,429 |
4,527 |
$77K |
| D8660 |
|
531 |
529 |
$70K |
| D8680 |
|
586 |
552 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,556 |
2,380 |
$52K |
| D3120 |
|
906 |
680 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
520 |
491 |
$31K |
| D0270 |
|
1,460 |
1,441 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
131 |
89 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
89 |
74 |
$8K |
| D2140 |
|
65 |
49 |
$5K |
| D2335 |
|
15 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
82 |
81 |
$2K |
| D2332 |
|
14 |
12 |
$1K |
| D1999 |
|
3,688 |
3,217 |
$0.00 |