| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
5,768 |
5,756 |
$1.63M |
| D1351 |
Sealant - per tooth |
17,299 |
3,606 |
$454K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,997 |
6,971 |
$432K |
| D0120 |
Periodic oral evaluation - established patient |
7,605 |
7,568 |
$416K |
| D1120 |
Prophylaxis - child |
10,318 |
10,255 |
$381K |
| D0210 |
Intraoral - complete series of radiographic images |
6,353 |
6,346 |
$299K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,329 |
1,499 |
$220K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
151 |
151 |
$155K |
| D0274 |
Bitewings - four radiographic images |
8,288 |
8,255 |
$151K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,032 |
9,368 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,799 |
11,756 |
$125K |
| D1110 |
Prophylaxis - adult |
1,241 |
1,241 |
$104K |
| D7240 |
Removal of impacted tooth - completely bony |
433 |
151 |
$97K |
| D0350 |
|
10,393 |
3,230 |
$83K |
| D9430 |
|
1,787 |
1,715 |
$56K |
| D2140 |
|
503 |
297 |
$27K |
| D8680 |
|
58 |
29 |
$20K |
| D0470 |
|
147 |
147 |
$11K |
| D0330 |
Panoramic radiographic image |
316 |
314 |
$8K |
| D0340 |
|
159 |
159 |
$8K |
| D2160 |
|
93 |
69 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
56 |
24 |
$7K |
| D1310 |
|
42 |
42 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
76 |
74 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
175 |
173 |
$1K |
| D9993 |
|
12 |
12 |
$650.00 |
| D0603 |
|
42 |
42 |
$525.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$480.00 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$288.00 |
| D0273 |
|
13 |
13 |
$0.00 |