| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
6,352 |
5,236 |
$441K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,719 |
1,337 |
$189K |
| D1110 |
Prophylaxis - adult |
2,806 |
2,689 |
$114K |
| D7240 |
Removal of impacted tooth - completely bony |
466 |
145 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
4,190 |
4,024 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,496 |
810 |
$89K |
| D1120 |
Prophylaxis - child |
2,750 |
2,629 |
$86K |
| D9243 |
|
948 |
346 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,330 |
1,983 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
785 |
475 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,758 |
2,724 |
$55K |
| D0330 |
Panoramic radiographic image |
2,040 |
1,904 |
$52K |
| D0272 |
Bitewings - two radiographic images |
2,933 |
2,846 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,994 |
1,891 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,278 |
2,105 |
$42K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
38 |
30 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,318 |
1,257 |
$35K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
423 |
92 |
$33K |
| D9239 |
|
352 |
319 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
433 |
188 |
$25K |
| D8660 |
|
375 |
371 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
115 |
40 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,101 |
1,021 |
$11K |
| D0340 |
|
174 |
171 |
$10K |
| D1351 |
Sealant - per tooth |
354 |
106 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
431 |
414 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
147 |
147 |
$9K |
| D9222 |
|
87 |
80 |
$7K |
| D2950 |
|
48 |
38 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
56 |
28 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
250 |
150 |
$2K |
| D2330 |
|
22 |
12 |
$1K |
| D2394 |
|
14 |
12 |
$1K |
| D1999 |
|
139 |
103 |
$0.00 |