| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,582 |
2,570 |
$751K |
| D0120 |
Periodic oral evaluation - established patient |
2,808 |
2,796 |
$177K |
| D0350 |
|
15,164 |
3,807 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,818 |
993 |
$121K |
| D1120 |
Prophylaxis - child |
3,018 |
2,988 |
$119K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,535 |
1,513 |
$96K |
| D0340 |
|
1,890 |
1,876 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,650 |
839 |
$89K |
| D1351 |
Sealant - per tooth |
2,732 |
753 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,609 |
1,595 |
$74K |
| D1110 |
Prophylaxis - adult |
822 |
820 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,951 |
3,572 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,950 |
3,914 |
$48K |
| D0274 |
Bitewings - four radiographic images |
2,271 |
2,262 |
$48K |
| D0330 |
Panoramic radiographic image |
1,634 |
1,628 |
$47K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
90 |
71 |
$43K |
| D9430 |
|
1,270 |
1,208 |
$40K |
| D4910 |
|
477 |
475 |
$36K |
| D1320 |
|
1,740 |
1,732 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
376 |
375 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
99 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
874 |
767 |
$10K |
| D2330 |
|
107 |
59 |
$8K |
| D4341 |
|
112 |
29 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
33 |
12 |
$8K |
| D0272 |
Bitewings - two radiographic images |
133 |
132 |
$2K |
| D1206 |
Topical application of fluoride varnish |
149 |
148 |
$2K |
| D1999 |
|
63 |
62 |
$46.00 |