| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,509 |
3,507 |
$764K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,982 |
1,888 |
$401K |
| D1110 |
Prophylaxis - adult |
5,599 |
5,536 |
$356K |
| D2721 |
|
309 |
207 |
$333K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,514 |
1,811 |
$331K |
| D1206 |
Topical application of fluoride varnish |
8,051 |
7,964 |
$251K |
| D0120 |
Periodic oral evaluation - established patient |
7,226 |
7,155 |
$243K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,072 |
942 |
$210K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,378 |
658 |
$201K |
| D0330 |
Panoramic radiographic image |
2,516 |
2,466 |
$197K |
| D1120 |
Prophylaxis - child |
3,995 |
3,976 |
$172K |
| D0274 |
Bitewings - four radiographic images |
3,721 |
3,673 |
$149K |
| D2331 |
|
1,248 |
820 |
$147K |
| D2160 |
|
1,272 |
928 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,793 |
1,069 |
$140K |
| D0140 |
Limited oral evaluation - problem focused |
4,260 |
4,086 |
$138K |
| D1354 |
|
3,651 |
576 |
$132K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
947 |
644 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,048 |
2,038 |
$92K |
| D2140 |
|
1,226 |
745 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
4,599 |
4,477 |
$80K |
| D0272 |
Bitewings - two radiographic images |
2,304 |
2,276 |
$78K |
| D1330 |
|
2,154 |
2,079 |
$61K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
21 |
21 |
$44K |
| D2335 |
|
303 |
189 |
$43K |
| D2161 |
|
261 |
209 |
$38K |
| D1310 |
|
1,186 |
1,182 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,549 |
1,492 |
$34K |
| D1351 |
Sealant - per tooth |
1,051 |
347 |
$33K |
| D2332 |
|
221 |
152 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,668 |
2,198 |
$27K |
| D2950 |
|
80 |
56 |
$16K |
| D0340 |
|
94 |
94 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
35 |
24 |
$7K |
| D2330 |
|
78 |
57 |
$6K |
| D2394 |
|
36 |
26 |
$5K |
| D9110 |
|
14 |
13 |
$589.96 |