| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,095 |
3,027 |
$779K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
171 |
169 |
$163K |
| D8680 |
|
257 |
255 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
603 |
335 |
$36K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
328 |
159 |
$32K |
| D1120 |
Prophylaxis - child |
878 |
833 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
532 |
488 |
$23K |
| D1206 |
Topical application of fluoride varnish |
959 |
906 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
883 |
838 |
$17K |
| D0330 |
Panoramic radiographic image |
442 |
416 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
180 |
107 |
$12K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
38 |
34 |
$11K |
| D0272 |
Bitewings - two radiographic images |
566 |
531 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
454 |
431 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
124 |
72 |
$6K |
| D1110 |
Prophylaxis - adult |
161 |
149 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
115 |
107 |
$6K |
| D9222 |
|
38 |
34 |
$5K |
| D1351 |
Sealant - per tooth |
183 |
63 |
$4K |
| D0274 |
Bitewings - four radiographic images |
93 |
93 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
14 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
76 |
76 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
120 |
112 |
$943.20 |
| D8660 |
|
13 |
12 |
$935.00 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$585.00 |
| D1999 |
|
933 |
818 |
$10.00 |
| D1330 |
|
795 |
754 |
$0.00 |
| D0603 |
|
153 |
153 |
$0.00 |
| D0601 |
|
166 |
166 |
$0.00 |
| D1310 |
|
353 |
353 |
$0.00 |