| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
4,490 |
4,416 |
$1.04M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
404 |
402 |
$424K |
| D0140 |
Limited oral evaluation - problem focused |
9,763 |
9,742 |
$340K |
| D0330 |
Panoramic radiographic image |
9,453 |
9,439 |
$281K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
572 |
555 |
$258K |
| D7240 |
Removal of impacted tooth - completely bony |
317 |
120 |
$73K |
| D9222 |
|
557 |
555 |
$67K |
| D7230 |
|
254 |
94 |
$48K |
| D9610 |
|
544 |
541 |
$45K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
293 |
41 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
496 |
496 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
263 |
49 |
$26K |
| D0470 |
|
277 |
277 |
$20K |
| D1351 |
Sealant - per tooth |
915 |
266 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
277 |
177 |
$18K |
| D1120 |
Prophylaxis - child |
551 |
537 |
$16K |
| D7241 |
|
49 |
13 |
$16K |
| D0340 |
|
279 |
279 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,464 |
483 |
$11K |
| D0274 |
Bitewings - four radiographic images |
532 |
517 |
$10K |
| D2140 |
|
142 |
97 |
$8K |
| D1206 |
Topical application of fluoride varnish |
559 |
545 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
79 |
79 |
$4K |
| D0350 |
|
295 |
183 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
141 |
138 |
$2K |
| D2160 |
|
18 |
14 |
$1K |
| D9430 |
|
13 |
13 |
$416.00 |
| D1999 |
|
838 |
837 |
$50.00 |
| D0601 |
|
388 |
377 |
$15.00 |
| D0120 |
Periodic oral evaluation - established patient |
50 |
50 |
$0.00 |
| D0603 |
|
84 |
82 |
$0.00 |
| D1330 |
|
297 |
283 |
$0.00 |