| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,473 |
1,428 |
$385K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
665 |
591 |
$227K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,358 |
2,726 |
$214K |
| D1110 |
Prophylaxis - adult |
6,798 |
6,351 |
$207K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,021 |
1,625 |
$203K |
| D8030 |
|
2,112 |
1,909 |
$174K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,741 |
1,925 |
$160K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,702 |
1,733 |
$128K |
| D2335 |
|
1,533 |
908 |
$127K |
| D2394 |
|
1,763 |
1,238 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
7,219 |
6,764 |
$112K |
| D0330 |
Panoramic radiographic image |
2,546 |
2,352 |
$96K |
| D0274 |
Bitewings - four radiographic images |
4,983 |
4,619 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,947 |
3,742 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,295 |
2,149 |
$57K |
| D2332 |
|
896 |
580 |
$56K |
| D3320 |
|
233 |
183 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
2,613 |
2,346 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
976 |
511 |
$49K |
| D2331 |
|
884 |
591 |
$48K |
| D1120 |
Prophylaxis - child |
2,399 |
2,283 |
$45K |
| D3310 |
|
151 |
104 |
$29K |
| D2330 |
|
584 |
368 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
5,989 |
5,213 |
$24K |
| D0340 |
|
412 |
395 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
353 |
240 |
$19K |
| D8680 |
|
92 |
45 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,860 |
1,759 |
$15K |
| D2160 |
|
222 |
175 |
$14K |
| D2161 |
|
163 |
127 |
$12K |
| D2140 |
|
238 |
170 |
$9K |
| D0272 |
Bitewings - two radiographic images |
803 |
766 |
$8K |
| D0350 |
|
542 |
523 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
322 |
228 |
$6K |
| D1351 |
Sealant - per tooth |
269 |
66 |
$5K |
| D9944 |
|
17 |
15 |
$3K |
| D0470 |
|
46 |
43 |
$990.90 |