| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
28,232 |
21,279 |
$2.47M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,221 |
915 |
$985K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,204 |
746 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,142 |
2,745 |
$99K |
| D0330 |
Panoramic radiographic image |
2,917 |
2,354 |
$97K |
| D0340 |
|
1,483 |
1,206 |
$61K |
| D0470 |
|
1,137 |
687 |
$58K |
| D0350 |
|
1,847 |
1,380 |
$51K |
| D1120 |
Prophylaxis - child |
1,689 |
1,595 |
$42K |
| D1516 |
|
201 |
160 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,229 |
1,170 |
$27K |
| D1515 |
|
170 |
86 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
201 |
150 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
306 |
187 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
181 |
126 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,536 |
1,451 |
$23K |
| D9310 |
|
659 |
475 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
136 |
109 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
298 |
248 |
$10K |
| D1351 |
Sealant - per tooth |
388 |
151 |
$10K |
| D0272 |
Bitewings - two radiographic images |
234 |
232 |
$4K |
| D3222 |
|
29 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
162 |
151 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
49 |
48 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
14 |
14 |
$352.82 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
25 |
$289.97 |