| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
6,197 |
5,782 |
$1.53M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
288 |
261 |
$320K |
| D1110 |
Prophylaxis - adult |
4,175 |
3,888 |
$220K |
| D0120 |
Periodic oral evaluation - established patient |
6,474 |
6,072 |
$159K |
| D1120 |
Prophylaxis - child |
3,418 |
3,246 |
$158K |
| D0274 |
Bitewings - four radiographic images |
4,010 |
3,737 |
$143K |
| D8680 |
|
1,495 |
1,390 |
$132K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,472 |
4,238 |
$123K |
| D0140 |
Limited oral evaluation - problem focused |
2,435 |
2,278 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
939 |
479 |
$75K |
| D1351 |
Sealant - per tooth |
1,946 |
426 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
846 |
430 |
$60K |
| D8660 |
|
1,277 |
1,122 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
991 |
894 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
298 |
179 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,273 |
2,143 |
$35K |
| D8690 |
|
220 |
218 |
$29K |
| D0272 |
Bitewings - two radiographic images |
913 |
894 |
$26K |
| D9310 |
|
624 |
426 |
$26K |
| D2740 |
Crown - porcelain/ceramic |
20 |
16 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
656 |
524 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
99 |
60 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
29 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
12 |
$818.00 |
| D1203 |
|
138 |
131 |
$0.00 |