| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
4,229 |
4,138 |
$1.37M |
| D1110 |
Prophylaxis - adult |
11,967 |
11,640 |
$453K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
449 |
442 |
$371K |
| D0120 |
Periodic oral evaluation - established patient |
16,801 |
16,503 |
$283K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,847 |
1,673 |
$230K |
| D8660 |
|
1,033 |
1,023 |
$167K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,941 |
7,869 |
$157K |
| D1120 |
Prophylaxis - child |
5,005 |
4,956 |
$153K |
| D0274 |
Bitewings - four radiographic images |
5,739 |
5,566 |
$125K |
| D0330 |
Panoramic radiographic image |
3,365 |
2,398 |
$123K |
| D8680 |
|
330 |
330 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,832 |
1,206 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,136 |
816 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
3,577 |
2,745 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,648 |
1,995 |
$60K |
| D2140 |
|
426 |
269 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
339 |
217 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,016 |
1,002 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,732 |
1,290 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
96 |
42 |
$8K |
| D0272 |
Bitewings - two radiographic images |
242 |
227 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
54 |
$2K |
| D2331 |
|
20 |
14 |
$2K |
| D2950 |
|
12 |
12 |
$1K |
| D2330 |
|
18 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$404.88 |
| D9986 |
|
149 |
139 |
$0.00 |
| D1999 |
|
1,662 |
1,372 |
$0.00 |