| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
4,297 |
4,245 |
$1.11M |
| D1120 |
Prophylaxis - child |
18,900 |
18,855 |
$980K |
| D2740 |
Crown - porcelain/ceramic |
1,237 |
602 |
$856K |
| D1351 |
Sealant - per tooth |
19,020 |
6,301 |
$783K |
| D0120 |
Periodic oral evaluation - established patient |
25,935 |
25,863 |
$753K |
| D1206 |
Topical application of fluoride varnish |
26,174 |
26,098 |
$694K |
| D1110 |
Prophylaxis - adult |
9,409 |
9,380 |
$620K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,988 |
4,063 |
$599K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,156 |
3,227 |
$538K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,658 |
1,187 |
$522K |
| D0274 |
Bitewings - four radiographic images |
12,008 |
11,980 |
$507K |
| D0272 |
Bitewings - two radiographic images |
10,808 |
10,779 |
$327K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
261 |
259 |
$313K |
| D0330 |
Panoramic radiographic image |
5,220 |
5,195 |
$197K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,946 |
1,234 |
$192K |
| D0220 |
Intraoral - periapical first radiographic image |
8,583 |
8,364 |
$159K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,894 |
2,879 |
$144K |
| D7111 |
|
1,648 |
1,083 |
$127K |
| D0140 |
Limited oral evaluation - problem focused |
2,648 |
2,583 |
$111K |
| D9945 |
|
357 |
353 |
$103K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,664 |
5,046 |
$85K |
| D8690 |
|
635 |
635 |
$81K |
| D8660 |
|
593 |
577 |
$76K |
| D8680 |
|
700 |
651 |
$64K |
| D3120 |
|
1,333 |
729 |
$49K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
78 |
41 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
404 |
333 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
533 |
529 |
$36K |
| D2954 |
|
154 |
106 |
$30K |
| D7240 |
Removal of impacted tooth - completely bony |
79 |
25 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
305 |
222 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
873 |
794 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
53 |
$12K |
| D2335 |
|
69 |
51 |
$11K |
| D0270 |
|
703 |
678 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
49 |
36 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
72 |
71 |
$2K |
| D2140 |
|
21 |
15 |
$2K |
| D8999 |
|
15 |
13 |
$810.00 |
| D1999 |
|
4,738 |
3,983 |
$0.00 |
| D9944 |
|
44 |
44 |
$0.00 |
| D0350 |
|
24 |
24 |
$0.00 |