| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,741 |
1,700 |
$511K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
984 |
461 |
$92K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
93 |
93 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
823 |
360 |
$58K |
| D1110 |
Prophylaxis - adult |
1,244 |
1,197 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,922 |
1,851 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,614 |
1,545 |
$27K |
| D1120 |
Prophylaxis - child |
861 |
824 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
576 |
508 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
464 |
412 |
$15K |
| D0274 |
Bitewings - four radiographic images |
514 |
492 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
926 |
868 |
$12K |
| D0272 |
Bitewings - two radiographic images |
506 |
478 |
$9K |
| D0330 |
Panoramic radiographic image |
153 |
140 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
658 |
530 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
38 |
$7K |
| D0340 |
|
134 |
126 |
$6K |
| D0470 |
|
133 |
125 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
26 |
$5K |
| D2335 |
|
34 |
17 |
$4K |
| D8660 |
|
59 |
59 |
$3K |
| D9110 |
|
53 |
53 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$425.02 |
| D0240 |
|
25 |
13 |
$337.83 |