| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,259 |
1,250 |
$364K |
| D8030 |
|
1,936 |
1,885 |
$163K |
| D0210 |
Intraoral - complete series of radiographic images |
2,199 |
2,141 |
$133K |
| D1110 |
Prophylaxis - adult |
3,209 |
3,175 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
4,419 |
4,376 |
$82K |
| D1320 |
|
4,761 |
4,722 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,423 |
584 |
$77K |
| D0274 |
Bitewings - four radiographic images |
3,244 |
3,222 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,373 |
2,356 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,212 |
3,183 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,188 |
3,686 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,410 |
1,369 |
$31K |
| D1120 |
Prophylaxis - child |
1,482 |
1,467 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
4,225 |
4,148 |
$23K |
| D2394 |
|
248 |
172 |
$18K |
| D8680 |
|
81 |
40 |
$17K |
| D0330 |
Panoramic radiographic image |
347 |
339 |
$15K |
| D1351 |
Sealant - per tooth |
650 |
110 |
$13K |
| D0470 |
|
523 |
346 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
102 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
169 |
115 |
$9K |
| D0340 |
|
146 |
143 |
$8K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
12 |
12 |
$7K |
| D0272 |
Bitewings - two radiographic images |
619 |
609 |
$6K |
| D0350 |
|
584 |
244 |
$5K |
| D2335 |
|
56 |
27 |
$5K |
| D2140 |
|
67 |
28 |
$3K |
| D2160 |
|
37 |
24 |
$2K |
| D0321 |
|
12 |
12 |
$569.47 |
| D1321 |
|
25 |
25 |
$375.00 |