| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,956 |
1,919 |
$188K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
938 |
519 |
$100K |
| D1120 |
Prophylaxis - child |
3,035 |
2,988 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,761 |
1,714 |
$79K |
| D1206 |
Topical application of fluoride varnish |
3,633 |
3,561 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,221 |
1,040 |
$57K |
| D1351 |
Sealant - per tooth |
1,937 |
428 |
$55K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
72 |
65 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,068 |
2,026 |
$54K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
303 |
150 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
411 |
252 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
463 |
250 |
$30K |
| D1110 |
Prophylaxis - adult |
750 |
739 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,195 |
844 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,262 |
1,227 |
$23K |
| D0240 |
|
1,272 |
665 |
$21K |
| D0330 |
Panoramic radiographic image |
359 |
350 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,219 |
1,172 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
430 |
404 |
$16K |
| D0470 |
|
268 |
250 |
$10K |
| D0274 |
Bitewings - four radiographic images |
320 |
315 |
$10K |