| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
29,694 |
29,667 |
$888K |
| D0330 |
Panoramic radiographic image |
20,940 |
20,914 |
$748K |
| D1110 |
Prophylaxis - adult |
10,622 |
10,619 |
$654K |
| D0210 |
Intraoral - complete series of radiographic images |
7,679 |
7,678 |
$501K |
| D1120 |
Prophylaxis - child |
5,565 |
5,563 |
$256K |
| D0220 |
Intraoral - periapical first radiographic image |
15,787 |
15,612 |
$235K |
| D1351 |
Sealant - per tooth |
4,627 |
1,273 |
$201K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,656 |
12,528 |
$163K |
| D0272 |
Bitewings - two radiographic images |
5,505 |
5,500 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,225 |
6,221 |
$91K |
| D1206 |
Topical application of fluoride varnish |
2,638 |
2,638 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
808 |
398 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,809 |
1,808 |
$54K |
| D8670 |
Periodic orthodontic treatment visit |
157 |
157 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,422 |
1,421 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
305 |
148 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
500 |
234 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
133 |
76 |
$14K |
| D7240 |
Removal of impacted tooth - completely bony |
43 |
16 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
210 |
126 |
$12K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
23 |
23 |
$12K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
20 |
17 |
$11K |
| D9243 |
|
38 |
38 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
109 |
64 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
65 |
$9K |
| D4341 |
|
163 |
66 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
19 |
14 |
$7K |
| D2954 |
|
46 |
35 |
$6K |
| D2161 |
|
45 |
38 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
370 |
370 |
$5K |
| D2394 |
|
39 |
33 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
60 |
49 |
$5K |
| D2335 |
|
30 |
20 |
$4K |
| D0270 |
|
272 |
272 |
$4K |
| D2332 |
|
34 |
24 |
$3K |
| D0340 |
|
62 |
62 |
$3K |
| D2160 |
|
24 |
20 |
$2K |
| D2330 |
|
35 |
23 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
23 |
21 |
$2K |
| D2331 |
|
14 |
12 |
$1K |
| D0350 |
|
113 |
113 |
$1K |
| D2140 |
|
22 |
19 |
$1K |
| D0470 |
|
28 |
28 |
$952.00 |
| D0273 |
|
38 |
38 |
$933.04 |
| D0145 |
Oral evaluation for a patient under three years of age |
22 |
22 |
$606.10 |
| D0160 |
|
22 |
22 |
$551.00 |