| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
28,220 |
24,311 |
$6.79M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
4,833 |
3,362 |
$1.35M |
| D7240 |
Removal of impacted tooth - completely bony |
5,736 |
2,751 |
$1.07M |
| D7140 |
Extraction, erupted tooth or exposed root |
21,594 |
8,174 |
$1.06M |
| D0120 |
Periodic oral evaluation - established patient |
39,326 |
38,559 |
$970K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,955 |
2,142 |
$867K |
| D0140 |
Limited oral evaluation - problem focused |
34,758 |
31,678 |
$855K |
| D1206 |
Topical application of fluoride varnish |
47,666 |
46,592 |
$826K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21,693 |
20,872 |
$821K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,295 |
3,033 |
$796K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,684 |
7,271 |
$677K |
| D1120 |
Prophylaxis - child |
29,852 |
29,408 |
$657K |
| D1110 |
Prophylaxis - adult |
15,863 |
15,386 |
$623K |
| D0330 |
Panoramic radiographic image |
13,642 |
13,014 |
$506K |
| D8670 |
Periodic orthodontic treatment visit |
2,835 |
2,063 |
$473K |
| D7230 |
|
2,880 |
1,565 |
$472K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,791 |
5,776 |
$430K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,720 |
1,953 |
$351K |
| D1351 |
Sealant - per tooth |
15,354 |
4,683 |
$323K |
| D9222 |
|
3,196 |
3,056 |
$307K |
| D9920 |
|
8,369 |
7,562 |
$280K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,809 |
8,869 |
$234K |
| D8660 |
|
1,096 |
828 |
$233K |
| D0220 |
Intraoral - periapical first radiographic image |
22,934 |
21,374 |
$193K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,016 |
1,703 |
$172K |
| D4341 |
|
5,248 |
3,027 |
$171K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
913 |
869 |
$169K |
| D4910 |
|
3,442 |
3,251 |
$142K |
| D2331 |
|
2,145 |
1,510 |
$141K |
| D9612 |
|
2,748 |
2,647 |
$132K |
| D8030 |
|
594 |
391 |
$123K |
| D0274 |
Bitewings - four radiographic images |
9,559 |
9,154 |
$122K |
| D0272 |
Bitewings - two radiographic images |
12,212 |
11,962 |
$119K |
| D9999 |
Unspecified adjunctive procedure, by report |
4,220 |
4,171 |
$110K |
| D1999 |
|
7,821 |
6,594 |
$90K |
| D0160 |
|
2,378 |
2,287 |
$86K |
| D2335 |
|
766 |
547 |
$84K |
| D2330 |
|
1,628 |
1,123 |
$68K |
| D3310 |
|
162 |
133 |
$68K |
| D2332 |
|
692 |
536 |
$63K |
| D7220 |
|
524 |
276 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
1,512 |
1,338 |
$56K |
| D9110 |
|
727 |
632 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,323 |
7,765 |
$38K |
| D4342 |
|
2,308 |
1,317 |
$36K |
| D1354 |
|
10,322 |
2,986 |
$33K |
| D9248 |
|
668 |
589 |
$32K |
| D0270 |
|
3,602 |
3,319 |
$26K |
| D2394 |
|
208 |
161 |
$20K |
| D9992 |
|
1,107 |
973 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
88 |
56 |
$6K |
| D9995 |
|
280 |
250 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38 |
35 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
84 |
84 |
$2K |
| D9610 |
|
20 |
18 |
$1K |
| D9996 |
|
89 |
88 |
$870.00 |
| D9420 |
|
13 |
12 |
$754.26 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
20 |
17 |
$665.44 |
| D0170 |
|
13 |
12 |
$449.60 |
| D0364 |
|
192 |
177 |
$0.00 |
| D0380 |
|
906 |
876 |
$0.00 |
| D0180 |
|
306 |
306 |
$0.00 |
| D2950 |
|
365 |
335 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
292 |
264 |
$0.00 |
| D0190 |
|
105 |
104 |
$0.00 |