| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
22,923 |
22,285 |
$1.69M |
| D0120 |
Periodic oral evaluation - established patient |
22,402 |
22,114 |
$660K |
| D1120 |
Prophylaxis - child |
14,943 |
14,737 |
$642K |
| D1110 |
Prophylaxis - adult |
9,707 |
9,575 |
$587K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,896 |
24,559 |
$570K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
553 |
539 |
$564K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,445 |
2,419 |
$554K |
| D8660 |
|
3,381 |
3,304 |
$499K |
| D1351 |
Sealant - per tooth |
11,856 |
2,283 |
$406K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,568 |
830 |
$247K |
| D0274 |
Bitewings - four radiographic images |
9,812 |
9,669 |
$221K |
| D0330 |
Panoramic radiographic image |
4,824 |
4,731 |
$206K |
| D0140 |
Limited oral evaluation - problem focused |
4,193 |
3,986 |
$192K |
| D9310 |
|
3,867 |
3,790 |
$183K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,788 |
1,065 |
$171K |
| D0272 |
Bitewings - two radiographic images |
11,304 |
11,152 |
$171K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,178 |
642 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,031 |
1,993 |
$108K |
| D7240 |
Removal of impacted tooth - completely bony |
316 |
87 |
$83K |
| D1330 |
|
12,569 |
12,386 |
$76K |
| D8090 |
|
43 |
43 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,679 |
2,578 |
$29K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
180 |
108 |
$28K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
133 |
119 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
219 |
93 |
$22K |
| D1515 |
|
143 |
84 |
$21K |
| D1516 |
|
115 |
112 |
$17K |
| D4355 |
|
99 |
98 |
$10K |
| D1206 |
Topical application of fluoride varnish |
382 |
382 |
$10K |
| D9222 |
|
134 |
118 |
$9K |
| D1517 |
|
54 |
51 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
994 |
993 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
197 |
172 |
$4K |
| D3120 |
|
73 |
55 |
$3K |
| D2330 |
|
26 |
13 |
$2K |