| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
5,282 |
4,346 |
$496K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,898 |
1,717 |
$451K |
| D1120 |
Prophylaxis - child |
9,177 |
7,569 |
$228K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,546 |
1,047 |
$211K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,816 |
1,422 |
$202K |
| D0140 |
Limited oral evaluation - problem focused |
5,788 |
4,524 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
5,336 |
4,995 |
$141K |
| D0274 |
Bitewings - four radiographic images |
6,390 |
5,237 |
$132K |
| D1206 |
Topical application of fluoride varnish |
6,588 |
5,311 |
$131K |
| D0330 |
Panoramic radiographic image |
3,752 |
3,023 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,953 |
2,781 |
$100K |
| D1351 |
Sealant - per tooth |
2,820 |
410 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
4,042 |
3,424 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
287 |
164 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,776 |
1,656 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
703 |
340 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,145 |
574 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,375 |
938 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
116 |
27 |
$4K |
| D0272 |
Bitewings - two radiographic images |
209 |
175 |
$3K |
| D0340 |
|
27 |
26 |
$2K |
| D0350 |
|
28 |
27 |
$751.95 |
| D1110 |
Prophylaxis - adult |
29 |
28 |
$520.00 |