| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,587 |
1,583 |
$464K |
| D0350 |
|
16,091 |
4,331 |
$150K |
| D0340 |
|
2,503 |
2,489 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,681 |
1,672 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,527 |
858 |
$102K |
| D1351 |
Sealant - per tooth |
2,292 |
591 |
$85K |
| D1120 |
Prophylaxis - child |
1,303 |
1,297 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
808 |
808 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,318 |
1,309 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,014 |
577 |
$55K |
| D0330 |
Panoramic radiographic image |
1,791 |
1,775 |
$52K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
46 |
46 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,222 |
1,213 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
403 |
295 |
$32K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
60 |
50 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,948 |
1,408 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,632 |
1,623 |
$23K |
| D1320 |
|
1,894 |
1,888 |
$22K |
| D1110 |
Prophylaxis - adult |
154 |
154 |
$14K |
| D4910 |
|
159 |
159 |
$12K |
| D0272 |
Bitewings - two radiographic images |
722 |
722 |
$9K |
| D4341 |
|
99 |
25 |
$7K |
| D9430 |
|
175 |
171 |
$6K |
| D2954 |
|
37 |
28 |
$4K |
| D0470 |
|
47 |
47 |
$4K |
| D2331 |
|
17 |
13 |
$1K |