| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,634 |
2,630 |
$733K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
10,163 |
4,193 |
$680K |
| D2140 |
|
9,255 |
3,864 |
$502K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,913 |
7,892 |
$495K |
| D0120 |
Periodic oral evaluation - established patient |
7,368 |
7,334 |
$410K |
| D0210 |
Intraoral - complete series of radiographic images |
7,950 |
7,927 |
$369K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,650 |
1,301 |
$313K |
| D1120 |
Prophylaxis - child |
6,993 |
6,965 |
$270K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,512 |
8,678 |
$191K |
| D2160 |
|
1,994 |
1,077 |
$158K |
| D1110 |
Prophylaxis - adult |
1,810 |
1,805 |
$146K |
| D1351 |
Sealant - per tooth |
4,800 |
1,155 |
$140K |
| D0274 |
Bitewings - four radiographic images |
6,359 |
6,319 |
$130K |
| D0350 |
|
10,641 |
4,146 |
$105K |
| D4341 |
|
1,497 |
625 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,030 |
8,998 |
$104K |
| D0330 |
Panoramic radiographic image |
3,832 |
3,778 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
1,770 |
1,756 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
970 |
322 |
$55K |
| D9430 |
|
935 |
928 |
$29K |
| D9910 |
|
452 |
438 |
$24K |
| D2330 |
|
252 |
107 |
$19K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
77 |
50 |
$14K |
| D7240 |
Removal of impacted tooth - completely bony |
64 |
24 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
287 |
265 |
$11K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
14 |
14 |
$10K |
| D4342 |
|
225 |
107 |
$9K |
| D8680 |
|
26 |
13 |
$9K |
| D0272 |
Bitewings - two radiographic images |
608 |
606 |
$7K |
| D9222 |
|
51 |
50 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
115 |
$1K |
| D0470 |
|
13 |
13 |
$975.00 |
| D0340 |
|
13 |
13 |
$650.00 |
| D1999 |
|
12 |
12 |
$0.00 |
| D1330 |
|
524 |
522 |
$0.00 |