| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,358 |
1,358 |
$311K |
| D0330 |
Panoramic radiographic image |
2,850 |
2,830 |
$214K |
| D1110 |
Prophylaxis - adult |
3,841 |
3,824 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
5,282 |
5,264 |
$181K |
| D1206 |
Topical application of fluoride varnish |
6,020 |
6,000 |
$156K |
| D0140 |
Limited oral evaluation - problem focused |
4,167 |
4,086 |
$149K |
| D0274 |
Bitewings - four radiographic images |
3,418 |
3,404 |
$124K |
| D1120 |
Prophylaxis - child |
3,483 |
3,477 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,098 |
3,079 |
$111K |
| D2722 |
|
94 |
80 |
$102K |
| D0272 |
Bitewings - two radiographic images |
2,004 |
2,001 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
899 |
491 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
961 |
550 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,463 |
3,163 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
325 |
163 |
$48K |
| D1351 |
Sealant - per tooth |
1,218 |
204 |
$20K |
| D2950 |
|
87 |
76 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
116 |
50 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
147 |
81 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
86 |
43 |
$9K |
| D0340 |
|
66 |
66 |
$8K |
| D4910 |
|
39 |
39 |
$3K |
| D9920 |
|
126 |
123 |
$2K |
| D2140 |
|
34 |
14 |
$2K |
| D1330 |
|
301 |
301 |
$1K |
| D0350 |
|
14 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
120 |
96 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$0.00 |