| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,159 |
1,105 |
$207K |
| D1120 |
Prophylaxis - child |
3,204 |
3,013 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
2,788 |
2,608 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,879 |
2,710 |
$71K |
| D4341 |
|
367 |
249 |
$69K |
| D1351 |
Sealant - per tooth |
422 |
253 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,749 |
1,603 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
485 |
410 |
$28K |
| D0330 |
Panoramic radiographic image |
1,351 |
1,193 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,559 |
1,458 |
$22K |
| D1110 |
Prophylaxis - adult |
502 |
484 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
406 |
335 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
245 |
189 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
702 |
641 |
$11K |
| D9310 |
|
625 |
572 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
515 |
403 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
73 |
54 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,696 |
1,505 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,199 |
1,064 |
$4K |
| D0272 |
Bitewings - two radiographic images |
262 |
242 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$1K |
| D9110 |
|
14 |
13 |
$770.00 |
| D8999 |
|
14 |
12 |
$470.50 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$286.00 |
| D0270 |
|
25 |
24 |
$125.10 |
| D1999 |
|
47 |
40 |
$0.00 |