| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8030 |
|
10,734 |
10,100 |
$536K |
| D8670 |
Periodic orthodontic treatment visit |
3,089 |
2,353 |
$482K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
776 |
667 |
$429K |
| D8680 |
|
692 |
309 |
$110K |
| D0330 |
Panoramic radiographic image |
2,946 |
2,559 |
$87K |
| D1110 |
Prophylaxis - adult |
2,424 |
2,182 |
$64K |
| D0340 |
|
1,428 |
1,214 |
$64K |
| D0470 |
|
3,522 |
1,659 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,491 |
2,124 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,563 |
2,291 |
$39K |
| D0350 |
|
5,625 |
2,057 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
851 |
442 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
2,643 |
2,390 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
861 |
395 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,498 |
2,239 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
641 |
291 |
$28K |
| D1120 |
Prophylaxis - child |
1,187 |
1,026 |
$17K |
| D1351 |
Sealant - per tooth |
1,068 |
220 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
1,042 |
895 |
$16K |
| D4211 |
|
155 |
81 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
211 |
89 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,079 |
959 |
$9K |
| D2332 |
|
60 |
29 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
685 |
540 |
$2K |
| D0240 |
|
212 |
94 |
$2K |
| D2394 |
|
17 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
133 |
86 |
$605.00 |
| D1206 |
Topical application of fluoride varnish |
51 |
46 |
$60.00 |