| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8680 |
|
1,091 |
1,060 |
$1.35M |
| D8670 |
Periodic orthodontic treatment visit |
12,150 |
11,786 |
$606K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
753 |
730 |
$511K |
| D0330 |
Panoramic radiographic image |
14,116 |
13,965 |
$447K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,654 |
3,507 |
$363K |
| D9310 |
|
21,576 |
21,382 |
$271K |
| D1351 |
Sealant - per tooth |
17,879 |
3,783 |
$208K |
| D1120 |
Prophylaxis - child |
10,228 |
10,227 |
$199K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,385 |
2,517 |
$188K |
| D0120 |
Periodic oral evaluation - established patient |
10,815 |
10,813 |
$175K |
| D1110 |
Prophylaxis - adult |
3,623 |
3,623 |
$158K |
| D1206 |
Topical application of fluoride varnish |
11,914 |
11,899 |
$150K |
| D7230 |
|
571 |
266 |
$120K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
207 |
183 |
$112K |
| D0340 |
|
4,528 |
4,488 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
1,201 |
1,200 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,664 |
4,554 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
442 |
348 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,190 |
2,190 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
10,025 |
10,004 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,886 |
8,763 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
414 |
225 |
$32K |
| D7240 |
Removal of impacted tooth - completely bony |
115 |
56 |
$32K |
| D0274 |
Bitewings - four radiographic images |
2,973 |
2,972 |
$31K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
47 |
46 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
888 |
885 |
$26K |
| D0272 |
Bitewings - two radiographic images |
4,221 |
4,221 |
$25K |
| D0603 |
|
3,544 |
3,542 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
480 |
332 |
$16K |
| D2950 |
|
241 |
209 |
$13K |
| D0601 |
|
2,549 |
2,548 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
174 |
111 |
$9K |
| D9920 |
|
581 |
571 |
$7K |
| D0350 |
|
5,595 |
5,525 |
$7K |
| D7111 |
|
161 |
104 |
$6K |
| D3320 |
|
12 |
12 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
58 |
34 |
$5K |
| D2932 |
|
32 |
12 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
285 |
285 |
$4K |
| D2330 |
|
74 |
47 |
$3K |
| D2332 |
|
48 |
27 |
$3K |
| D2954 |
|
17 |
12 |
$2K |
| D0602 |
|
176 |
176 |
$1K |
| D8704 |
|
12 |
12 |
$900.00 |
| D8692 |
|
12 |
12 |
$890.00 |
| D8660 |
|
2,729 |
2,705 |
$555.00 |
| D0270 |
|
12 |
12 |
$60.00 |