| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
5,884 |
5,756 |
$2.16M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
621 |
606 |
$617K |
| D8660 |
|
3,308 |
3,246 |
$609K |
| D1120 |
Prophylaxis - child |
14,155 |
14,063 |
$374K |
| D1206 |
Topical application of fluoride varnish |
19,647 |
19,521 |
$323K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,336 |
2,728 |
$293K |
| D0120 |
Periodic oral evaluation - established patient |
14,341 |
14,266 |
$230K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,922 |
2,223 |
$224K |
| D1110 |
Prophylaxis - adult |
5,323 |
5,288 |
$194K |
| D1351 |
Sealant - per tooth |
6,040 |
1,978 |
$156K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,950 |
5,511 |
$153K |
| D9630 |
|
9,381 |
9,200 |
$142K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
961 |
420 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,513 |
4,463 |
$103K |
| D0272 |
Bitewings - two radiographic images |
4,917 |
4,876 |
$80K |
| D0274 |
Bitewings - four radiographic images |
3,682 |
3,643 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,201 |
678 |
$78K |
| D9920 |
|
961 |
927 |
$63K |
| D8680 |
|
193 |
193 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,735 |
1,653 |
$60K |
| D0240 |
|
8,110 |
4,150 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
286 |
162 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,303 |
1,279 |
$27K |
| D3120 |
|
1,392 |
763 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,792 |
2,732 |
$23K |
| D9310 |
|
295 |
295 |
$23K |
| D1354 |
|
1,479 |
462 |
$19K |
| D0330 |
Panoramic radiographic image |
326 |
320 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,719 |
903 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
580 |
580 |
$11K |
| D2332 |
|
59 |
38 |
$7K |
| D8703 |
|
15 |
13 |
$2K |
| D8704 |
|
15 |
13 |
$2K |
| D2330 |
|
24 |
16 |
$2K |