| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
3,080 |
2,939 |
$1.57M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,007 |
3,200 |
$1.31M |
| D7140 |
Extraction, erupted tooth or exposed root |
27,154 |
7,465 |
$1.24M |
| D8670 |
Periodic orthodontic treatment visit |
3,605 |
3,582 |
$1.22M |
| D1120 |
Prophylaxis - child |
23,742 |
23,539 |
$658K |
| D1206 |
Topical application of fluoride varnish |
30,584 |
30,300 |
$522K |
| D7240 |
Removal of impacted tooth - completely bony |
2,835 |
811 |
$518K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
443 |
443 |
$373K |
| D0120 |
Periodic oral evaluation - established patient |
22,107 |
21,925 |
$364K |
| D0140 |
Limited oral evaluation - problem focused |
20,230 |
15,973 |
$357K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,602 |
1,125 |
$329K |
| D1351 |
Sealant - per tooth |
12,034 |
3,997 |
$327K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,715 |
3,139 |
$301K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,237 |
2,171 |
$293K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,564 |
2,443 |
$281K |
| D3320 |
|
827 |
757 |
$278K |
| D1110 |
Prophylaxis - adult |
6,915 |
6,817 |
$254K |
| D0330 |
Panoramic radiographic image |
7,055 |
4,984 |
$248K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,217 |
8,061 |
$204K |
| D3310 |
|
674 |
532 |
$196K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,569 |
6,216 |
$184K |
| D0272 |
Bitewings - two radiographic images |
9,386 |
9,303 |
$159K |
| D0210 |
Intraoral - complete series of radiographic images |
3,454 |
3,159 |
$117K |
| D9248 |
|
1,095 |
1,063 |
$111K |
| D9310 |
|
1,487 |
1,442 |
$102K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,112 |
1,386 |
$92K |
| D0274 |
Bitewings - four radiographic images |
4,109 |
4,067 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
9,920 |
9,256 |
$87K |
| D9222 |
|
2,022 |
1,465 |
$86K |
| D9630 |
|
4,989 |
4,897 |
$80K |
| D8680 |
|
175 |
171 |
$62K |
| D8660 |
|
451 |
451 |
$61K |
| D2330 |
|
749 |
480 |
$51K |
| D7230 |
|
343 |
136 |
$42K |
| D1354 |
|
3,140 |
1,276 |
$41K |
| D3120 |
|
2,184 |
1,098 |
$37K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,706 |
1,682 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,110 |
1,985 |
$30K |
| D0240 |
|
3,158 |
2,578 |
$27K |
| D4341 |
|
423 |
149 |
$24K |
| D1510 |
|
167 |
128 |
$17K |
| D4910 |
|
457 |
453 |
$17K |
| D2390 |
|
133 |
48 |
$16K |
| D2940 |
|
263 |
180 |
$11K |
| D2929 |
|
34 |
14 |
$6K |
| D2331 |
|
53 |
38 |
$4K |
| D7310 |
|
55 |
13 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
102 |
102 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
36 |
30 |
$1K |
| D0270 |
|
90 |
80 |
$950.30 |
| D9420 |
|
14 |
14 |
$903.84 |
| D7111 |
|
29 |
24 |
$533.89 |
| 70486 |
|
38 |
38 |
$376.92 |
| D9995 |
|
43 |
38 |
$350.00 |