| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
7,253 |
7,241 |
$1.60M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
207 |
205 |
$282K |
| D0330 |
Panoramic radiographic image |
3,425 |
3,355 |
$245K |
| D0140 |
Limited oral evaluation - problem focused |
7,568 |
7,198 |
$230K |
| D0340 |
|
2,665 |
2,637 |
$223K |
| D1110 |
Prophylaxis - adult |
4,730 |
4,705 |
$184K |
| D0350 |
|
2,486 |
2,460 |
$162K |
| D0274 |
Bitewings - four radiographic images |
2,946 |
2,930 |
$82K |
| D1351 |
Sealant - per tooth |
3,819 |
549 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,985 |
2,979 |
$75K |
| D0470 |
|
1,212 |
1,200 |
$72K |
| D1206 |
Topical application of fluoride varnish |
3,928 |
3,902 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
5,359 |
5,234 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,968 |
3,900 |
$35K |
| D2722 |
|
21 |
13 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
842 |
$20K |
| D1120 |
Prophylaxis - child |
790 |
786 |
$11K |
| D1330 |
|
287 |
287 |
$4K |
| D0272 |
Bitewings - two radiographic images |
330 |
329 |
$3K |
| D2332 |
|
27 |
13 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
135 |
85 |
$0.00 |
| D2140 |
|
19 |
14 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$0.00 |