| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
897 |
859 |
$223K |
| D1120 |
Prophylaxis - child |
4,082 |
3,838 |
$200K |
| D1110 |
Prophylaxis - adult |
3,556 |
3,341 |
$192K |
| D2740 |
Crown - porcelain/ceramic |
253 |
186 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
5,422 |
5,116 |
$138K |
| D1206 |
Topical application of fluoride varnish |
5,195 |
4,869 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,373 |
2,209 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,245 |
797 |
$106K |
| D0274 |
Bitewings - four radiographic images |
2,657 |
2,517 |
$95K |
| D0140 |
Limited oral evaluation - problem focused |
1,822 |
1,574 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
769 |
714 |
$51K |
| D1351 |
Sealant - per tooth |
1,192 |
297 |
$47K |
| D0330 |
Panoramic radiographic image |
613 |
593 |
$36K |
| D2950 |
|
244 |
191 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,094 |
1,018 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,351 |
1,191 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
211 |
143 |
$14K |
| D9310 |
|
172 |
154 |
$9K |
| D8660 |
|
209 |
207 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
40 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
40 |
$4K |
| D3120 |
|
114 |
88 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
183 |
165 |
$3K |
| D0180 |
|
18 |
18 |
$666.00 |
| D0270 |
|
32 |
26 |
$349.00 |
| D0603 |
|
406 |
400 |
$0.05 |
| D1310 |
|
28 |
28 |
$0.00 |
| D1330 |
|
30 |
29 |
$0.00 |
| D1999 |
|
1,038 |
945 |
$0.00 |