| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,128 |
3,063 |
$440K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,898 |
979 |
$357K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
304 |
290 |
$253K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,745 |
2,721 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
950 |
660 |
$124K |
| D0330 |
Panoramic radiographic image |
2,577 |
2,538 |
$117K |
| D3320 |
|
136 |
129 |
$84K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,469 |
2,119 |
$83K |
| D9310 |
|
1,733 |
1,711 |
$83K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
292 |
225 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,905 |
2,597 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,390 |
3,012 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
521 |
309 |
$48K |
| D1120 |
Prophylaxis - child |
775 |
775 |
$40K |
| D8660 |
|
739 |
737 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
178 |
178 |
$14K |
| D1206 |
Topical application of fluoride varnish |
742 |
742 |
$14K |
| D9430 |
|
267 |
264 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
92 |
75 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
45 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
35 |
16 |
$7K |
| D7230 |
|
19 |
13 |
$5K |
| D1351 |
Sealant - per tooth |
101 |
57 |
$4K |
| D1354 |
|
150 |
46 |
$4K |
| D1999 |
|
405 |
398 |
$4K |
| D0274 |
Bitewings - four radiographic images |
134 |
134 |
$3K |
| D0272 |
Bitewings - two radiographic images |
184 |
184 |
$3K |
| D0470 |
|
51 |
45 |
$2K |
| D1310 |
|
51 |
50 |
$2K |
| D0350 |
|
229 |
109 |
$1K |
| D0603 |
|
51 |
50 |
$645.06 |
| D0340 |
|
13 |
13 |
$520.00 |
| D4921 |
|
158 |
60 |
$320.00 |