| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,620 |
2,610 |
$595K |
| D1120 |
Prophylaxis - child |
15,325 |
15,294 |
$517K |
| D0274 |
Bitewings - four radiographic images |
15,765 |
15,761 |
$353K |
| D0120 |
Periodic oral evaluation - established patient |
15,738 |
15,704 |
$350K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,503 |
3,362 |
$287K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,982 |
2,374 |
$274K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,948 |
4,365 |
$257K |
| D1351 |
Sealant - per tooth |
5,444 |
2,580 |
$237K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,214 |
16,177 |
$196K |
| D0220 |
Intraoral - periapical first radiographic image |
17,497 |
17,464 |
$185K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,948 |
2,287 |
$124K |
| D9310 |
|
1,762 |
1,758 |
$96K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,389 |
1,179 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,434 |
16,423 |
$88K |
| D0340 |
|
1,922 |
1,922 |
$85K |
| D1110 |
Prophylaxis - adult |
1,721 |
1,721 |
$76K |
| D0470 |
|
2,236 |
2,236 |
$63K |
| D8660 |
|
2,183 |
2,182 |
$62K |
| D0330 |
Panoramic radiographic image |
1,452 |
1,452 |
$44K |
| D9990 |
|
1,625 |
1,610 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,450 |
1,450 |
$33K |
| D0350 |
|
2,266 |
2,266 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
619 |
619 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
655 |
655 |
$16K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
14 |
14 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
599 |
594 |
$7K |
| D2330 |
|
110 |
91 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
313 |
311 |
$3K |
| D0272 |
Bitewings - two radiographic images |
180 |
180 |
$2K |
| D2335 |
|
22 |
13 |
$2K |
| D1310 |
|
32 |
32 |
$0.00 |
| D0603 |
|
15 |
15 |
$0.00 |
| D1330 |
|
32 |
32 |
$0.00 |
| D1999 |
|
466 |
466 |
$0.00 |