| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
5,188 |
4,691 |
$453K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,536 |
490 |
$155K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,152 |
544 |
$111K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
703 |
390 |
$83K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
111 |
92 |
$68K |
| D4355 |
|
901 |
858 |
$55K |
| D0330 |
Panoramic radiographic image |
834 |
792 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
479 |
300 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,523 |
1,462 |
$34K |
| D2335 |
|
296 |
170 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,128 |
1,073 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,885 |
1,415 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
832 |
774 |
$30K |
| D8680 |
|
46 |
42 |
$30K |
| D2332 |
|
334 |
183 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
893 |
847 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,953 |
1,835 |
$27K |
| D1110 |
Prophylaxis - adult |
767 |
736 |
$27K |
| D1206 |
Topical application of fluoride varnish |
780 |
744 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
92 |
$11K |
| D0340 |
|
198 |
177 |
$9K |
| D2331 |
|
115 |
70 |
$8K |
| D1351 |
Sealant - per tooth |
336 |
75 |
$8K |
| D0470 |
|
198 |
177 |
$7K |
| D5110 |
|
18 |
12 |
$6K |
| D4341 |
|
63 |
27 |
$6K |
| D1120 |
Prophylaxis - child |
216 |
205 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
40 |
$3K |
| D2394 |
|
27 |
14 |
$3K |
| D2330 |
|
42 |
31 |
$3K |
| D0272 |
Bitewings - two radiographic images |
131 |
119 |
$2K |
| D5650 |
|
31 |
15 |
$2K |