| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
9,455 |
7,701 |
$743K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,898 |
1,646 |
$294K |
| D0120 |
Periodic oral evaluation - established patient |
10,432 |
9,862 |
$261K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
295 |
276 |
$218K |
| D1110 |
Prophylaxis - adult |
5,199 |
4,937 |
$189K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,217 |
1,237 |
$166K |
| D0330 |
Panoramic radiographic image |
3,849 |
3,452 |
$165K |
| D1120 |
Prophylaxis - child |
5,824 |
5,512 |
$155K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,138 |
7,587 |
$153K |
| D0140 |
Limited oral evaluation - problem focused |
4,102 |
3,792 |
$142K |
| D0220 |
Intraoral - periapical first radiographic image |
9,491 |
8,811 |
$132K |
| D0274 |
Bitewings - four radiographic images |
4,456 |
4,180 |
$130K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,101 |
900 |
$127K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
864 |
514 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,525 |
2,333 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,639 |
5,408 |
$94K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
699 |
338 |
$74K |
| D1206 |
Topical application of fluoride varnish |
4,246 |
3,922 |
$64K |
| D1351 |
Sealant - per tooth |
1,965 |
542 |
$55K |
| D0272 |
Bitewings - two radiographic images |
2,947 |
2,789 |
$51K |
| D0340 |
|
764 |
605 |
$27K |
| D0470 |
|
668 |
547 |
$21K |
| D8680 |
|
85 |
57 |
$20K |
| D0160 |
|
321 |
280 |
$19K |
| D4346 |
|
343 |
316 |
$12K |
| D7240 |
Removal of impacted tooth - completely bony |
40 |
13 |
$8K |
| D2394 |
|
42 |
26 |
$6K |
| D9239 |
|
86 |
77 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
89 |
80 |
$4K |
| D7250 |
|
32 |
12 |
$3K |
| D7311 |
|
20 |
13 |
$2K |
| D9243 |
|
21 |
20 |
$2K |
| D2332 |
|
15 |
13 |
$1K |
| D9612 |
|
21 |
20 |
$1K |
| D9610 |
|
41 |
33 |
$1K |
| D4355 |
|
14 |
12 |
$869.64 |
| D0350 |
|
37 |
34 |
$0.00 |