| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
8,697 |
8,670 |
$2.47M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
351 |
349 |
$355K |
| D8680 |
|
715 |
346 |
$231K |
| D0120 |
Periodic oral evaluation - established patient |
3,191 |
3,165 |
$188K |
| D1120 |
Prophylaxis - child |
3,744 |
3,730 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,708 |
1,697 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,517 |
1,085 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
2,050 |
2,037 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,011 |
488 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,818 |
1,809 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,196 |
2,186 |
$46K |
| D0330 |
Panoramic radiographic image |
1,003 |
988 |
$28K |
| D0470 |
|
349 |
347 |
$26K |
| D1320 |
|
3,248 |
3,232 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,316 |
2,267 |
$21K |
| D1351 |
Sealant - per tooth |
971 |
268 |
$18K |
| D0350 |
|
543 |
541 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,174 |
1,173 |
$16K |
| D0340 |
|
310 |
308 |
$15K |
| D1110 |
Prophylaxis - adult |
126 |
126 |
$11K |
| D1206 |
Topical application of fluoride varnish |
1,133 |
1,128 |
$9K |
| D7971 |
|
78 |
43 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
65 |
$5K |
| D9430 |
|
89 |
86 |
$3K |
| D1999 |
|
2,104 |
2,091 |
$2K |
| D0272 |
Bitewings - two radiographic images |
50 |
50 |
$576.00 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
24 |
$287.00 |