| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
625 |
545 |
$143K |
| D9310 |
|
952 |
921 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
289 |
120 |
$27K |
| D0330 |
Panoramic radiographic image |
445 |
432 |
$18K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
164 |
146 |
$13K |
| D1206 |
Topical application of fluoride varnish |
76 |
56 |
$8K |
| D1120 |
Prophylaxis - child |
82 |
62 |
$3K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
24 |
24 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
36 |
$2K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
14 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
55 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
27 |
17 |
$856.80 |
| D9222 |
|
15 |
15 |
$745.00 |
| D0170 |
|
15 |
13 |
$609.12 |
| D0171 |
|
38 |
36 |
$520.00 |
| D0274 |
Bitewings - four radiographic images |
23 |
12 |
$65.26 |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
13 |
$40.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
23 |
12 |
$19.94 |