| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
6,319 |
5,979 |
$1.52M |
| D2740 |
Crown - porcelain/ceramic |
2,052 |
1,081 |
$1.30M |
| D1110 |
Prophylaxis - adult |
18,734 |
17,712 |
$1.05M |
| D1120 |
Prophylaxis - child |
19,134 |
18,215 |
$928K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,795 |
6,325 |
$909K |
| D0120 |
Periodic oral evaluation - established patient |
33,141 |
31,399 |
$851K |
| D7240 |
Removal of impacted tooth - completely bony |
2,631 |
638 |
$730K |
| D1206 |
Topical application of fluoride varnish |
26,186 |
24,934 |
$660K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,732 |
4,901 |
$567K |
| D0274 |
Bitewings - four radiographic images |
13,725 |
12,944 |
$517K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
788 |
558 |
$447K |
| D1351 |
Sealant - per tooth |
11,215 |
3,568 |
$437K |
| D0140 |
Limited oral evaluation - problem focused |
8,159 |
7,432 |
$310K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
246 |
241 |
$290K |
| D0330 |
Panoramic radiographic image |
4,580 |
4,279 |
$261K |
| D2950 |
|
1,745 |
1,132 |
$247K |
| D0210 |
Intraoral - complete series of radiographic images |
3,498 |
3,257 |
$237K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,016 |
4,689 |
$218K |
| D0272 |
Bitewings - two radiographic images |
5,987 |
5,815 |
$171K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
774 |
341 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
6,805 |
6,119 |
$105K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,065 |
829 |
$103K |
| D3320 |
|
196 |
152 |
$98K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
463 |
358 |
$90K |
| D8680 |
|
1,007 |
926 |
$86K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,431 |
3,938 |
$83K |
| D8660 |
|
2,479 |
2,451 |
$82K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
728 |
499 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
683 |
462 |
$57K |
| D9310 |
|
473 |
419 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,568 |
1,100 |
$18K |
| D2140 |
|
230 |
157 |
$16K |
| D7111 |
|
194 |
135 |
$14K |
| D8690 |
|
106 |
105 |
$14K |
| D2330 |
|
196 |
134 |
$13K |
| D2331 |
|
138 |
102 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
14 |
$10K |
| D7230 |
|
59 |
24 |
$10K |
| D0270 |
|
745 |
706 |
$10K |
| D8999 |
|
137 |
126 |
$7K |
| D4341 |
|
61 |
25 |
$7K |
| D9110 |
|
146 |
136 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
166 |
164 |
$5K |
| D2954 |
|
38 |
13 |
$4K |
| D2332 |
|
22 |
14 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
82 |
79 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
12 |
$2K |
| D0180 |
|
29 |
28 |
$1K |
| D1354 |
|
26 |
12 |
$390.00 |
| D0603 |
|
4,730 |
4,687 |
$0.00 |
| D1999 |
|
5,396 |
4,919 |
$0.00 |
| D9430 |
|
50 |
49 |
$0.00 |