| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,333 |
2,209 |
$567K |
| D1110 |
Prophylaxis - adult |
8,048 |
7,441 |
$420K |
| D0120 |
Periodic oral evaluation - established patient |
12,415 |
11,577 |
$304K |
| D1120 |
Prophylaxis - child |
6,115 |
5,730 |
$293K |
| D1206 |
Topical application of fluoride varnish |
10,112 |
9,455 |
$241K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,251 |
497 |
$165K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,031 |
1,224 |
$163K |
| D0274 |
Bitewings - four radiographic images |
4,320 |
4,036 |
$149K |
| D0140 |
Limited oral evaluation - problem focused |
3,852 |
3,486 |
$135K |
| D7240 |
Removal of impacted tooth - completely bony |
460 |
133 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,264 |
2,101 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,204 |
1,127 |
$79K |
| D2740 |
Crown - porcelain/ceramic |
122 |
82 |
$72K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
103 |
59 |
$56K |
| D0330 |
Panoramic radiographic image |
875 |
825 |
$55K |
| D0272 |
Bitewings - two radiographic images |
1,930 |
1,823 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
762 |
411 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
2,849 |
2,522 |
$40K |
| D1351 |
Sealant - per tooth |
808 |
243 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,771 |
1,465 |
$29K |
| D7230 |
|
94 |
50 |
$21K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
14 |
13 |
$16K |
| D8660 |
|
330 |
320 |
$10K |
| D8690 |
|
55 |
55 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
64 |
37 |
$5K |
| D4341 |
|
38 |
12 |
$5K |
| D9310 |
|
73 |
69 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
259 |
186 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
28 |
$3K |
| D2950 |
|
25 |
12 |
$3K |
| D0180 |
|
64 |
61 |
$2K |
| D8680 |
|
15 |
13 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D0603 |
|
1,514 |
1,482 |
$0.00 |
| D0602 |
|
20 |
20 |
$0.00 |
| D9995 |
|
22 |
22 |
$0.00 |
| D1999 |
|
2,610 |
2,299 |
$0.00 |