| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
5,127 |
4,840 |
$295K |
| D1120 |
Prophylaxis - child |
3,149 |
3,103 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
790 |
385 |
$59K |
| D1351 |
Sealant - per tooth |
2,915 |
467 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,391 |
2,343 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,458 |
2,418 |
$36K |
| D0330 |
Panoramic radiographic image |
860 |
841 |
$29K |
| D9310 |
|
852 |
847 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,415 |
1,257 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,560 |
1,536 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
222 |
109 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
425 |
422 |
$10K |
| D2331 |
|
119 |
53 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
145 |
94 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
77 |
41 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
49 |
24 |
$5K |
| D0603 |
|
573 |
512 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
563 |
513 |
$4K |
| D1206 |
Topical application of fluoride varnish |
577 |
576 |
$3K |
| D8660 |
|
97 |
94 |
$3K |
| D2332 |
|
34 |
13 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
115 |
114 |
$3K |
| D0274 |
Bitewings - four radiographic images |
144 |
124 |
$2K |
| D0601 |
|
204 |
204 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
420 |
296 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$660.00 |
| D0350 |
|
245 |
213 |
$145.00 |
| D1110 |
Prophylaxis - adult |
35 |
35 |
$129.00 |
| D1354 |
|
26 |
12 |
$30.00 |
| D1330 |
|
44 |
28 |
$0.00 |