| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
4,422 |
4,410 |
$1.01M |
| D1351 |
Sealant - per tooth |
17,883 |
3,629 |
$445K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,091 |
3,125 |
$377K |
| D1110 |
Prophylaxis - adult |
6,833 |
6,796 |
$241K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
479 |
445 |
$230K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
227 |
226 |
$217K |
| D0330 |
Panoramic radiographic image |
5,352 |
5,314 |
$186K |
| D0274 |
Bitewings - four radiographic images |
6,703 |
6,658 |
$181K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,750 |
914 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
8,499 |
8,470 |
$167K |
| D1120 |
Prophylaxis - child |
5,430 |
5,401 |
$162K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,449 |
430 |
$152K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,788 |
7,747 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,766 |
1,819 |
$142K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,038 |
2,930 |
$136K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,576 |
854 |
$108K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,364 |
787 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,111 |
5,076 |
$101K |
| D8660 |
|
896 |
893 |
$95K |
| D0272 |
Bitewings - two radiographic images |
5,021 |
5,001 |
$82K |
| D9110 |
|
2,655 |
2,617 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,030 |
739 |
$69K |
| D9222 |
|
469 |
458 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
926 |
898 |
$49K |
| D7240 |
Removal of impacted tooth - completely bony |
235 |
87 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
4,418 |
4,289 |
$29K |
| D2332 |
|
347 |
213 |
$22K |
| D2330 |
|
245 |
160 |
$12K |
| D7230 |
|
74 |
48 |
$10K |
| D2331 |
|
156 |
111 |
$10K |
| D1330 |
|
830 |
828 |
$9K |
| D1310 |
|
675 |
674 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
754 |
708 |
$6K |
| D7220 |
|
68 |
41 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
19 |
12 |
$4K |
| D0240 |
|
130 |
130 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
25 |
14 |
$1K |
| D2335 |
|
17 |
13 |
$1K |
| D0270 |
|
94 |
93 |
$714.80 |
| D0340 |
|
22 |
22 |
$413.50 |
| D1999 |
|
37 |
36 |
$230.00 |