| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,632 |
2,572 |
$195K |
| D1120 |
Prophylaxis - child |
4,417 |
4,362 |
$193K |
| D1206 |
Topical application of fluoride varnish |
4,458 |
4,402 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
3,533 |
3,490 |
$105K |
| D9310 |
|
895 |
860 |
$42K |
| D7240 |
Removal of impacted tooth - completely bony |
109 |
41 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
391 |
384 |
$21K |
| D0330 |
Panoramic radiographic image |
442 |
429 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,134 |
1,114 |
$17K |
| D1330 |
|
2,557 |
2,515 |
$16K |
| D8660 |
|
100 |
100 |
$15K |
| D8999 |
|
27 |
27 |
$15K |
| D1351 |
Sealant - per tooth |
411 |
84 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
100 |
47 |
$11K |
| D9248 |
|
52 |
52 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
199 |
198 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
473 |
438 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
28 |
$4K |
| D0340 |
|
38 |
37 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
59 |
59 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
77 |
73 |
$784.06 |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
27 |
$229.60 |
| D0240 |
|
12 |
12 |
$216.00 |