| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,549 |
1,544 |
$339K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,874 |
1,270 |
$285K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,074 |
1,728 |
$177K |
| D0330 |
Panoramic radiographic image |
3,579 |
3,535 |
$129K |
| D1110 |
Prophylaxis - adult |
3,838 |
3,795 |
$127K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,318 |
1,331 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
5,985 |
5,922 |
$109K |
| D0274 |
Bitewings - four radiographic images |
4,087 |
4,029 |
$105K |
| D1351 |
Sealant - per tooth |
3,511 |
537 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,320 |
2,277 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
700 |
475 |
$44K |
| D2332 |
|
674 |
365 |
$41K |
| D1120 |
Prophylaxis - child |
1,032 |
1,022 |
$30K |
| D5110 |
|
56 |
56 |
$27K |
| D2330 |
|
528 |
288 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
519 |
508 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,810 |
3,656 |
$23K |
| D2331 |
|
370 |
236 |
$22K |
| D8030 |
|
247 |
233 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,114 |
1,104 |
$19K |
| D2335 |
|
226 |
155 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
624 |
614 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,231 |
1,068 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
29 |
26 |
$9K |
| D0272 |
Bitewings - two radiographic images |
569 |
561 |
$9K |
| D1330 |
|
626 |
624 |
$7K |
| D1310 |
|
626 |
624 |
$7K |
| D7240 |
Removal of impacted tooth - completely bony |
34 |
14 |
$7K |
| D5120 |
|
14 |
14 |
$6K |
| D2931 |
|
33 |
28 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
15 |
$3K |
| D2394 |
|
34 |
30 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
43 |
$2K |
| D1999 |
|
23 |
22 |
$42.00 |