| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
593 |
583 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
6,492 |
6,417 |
$153K |
| D1206 |
Topical application of fluoride varnish |
7,054 |
6,972 |
$149K |
| D1120 |
Prophylaxis - child |
4,579 |
4,527 |
$135K |
| D1110 |
Prophylaxis - adult |
2,185 |
2,163 |
$91K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,800 |
1,708 |
$67K |
| D0272 |
Bitewings - two radiographic images |
1,848 |
1,818 |
$37K |
| D1330 |
|
4,680 |
4,630 |
$28K |
| D1310 |
|
4,673 |
4,623 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
342 |
253 |
$23K |
| D0274 |
Bitewings - four radiographic images |
688 |
680 |
$22K |
| D0603 |
|
1,975 |
1,958 |
$19K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
12 |
12 |
$15K |
| D1351 |
Sealant - per tooth |
163 |
63 |
$9K |
| D0330 |
Panoramic radiographic image |
151 |
150 |
$7K |
| D0601 |
|
645 |
641 |
$6K |
| D9920 |
|
105 |
102 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
180 |
178 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
356 |
351 |
$3K |
| D2140 |
|
67 |
61 |
$3K |
| D0602 |
|
301 |
301 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
34 |
$3K |
| D8660 |
|
14 |
14 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
75 |
72 |
$823.39 |
| D0140 |
Limited oral evaluation - problem focused |
19 |
19 |
$528.33 |