| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
19,325 |
19,276 |
$1.07M |
| D8670 |
Periodic orthodontic treatment visit |
3,118 |
3,117 |
$867K |
| D1120 |
Prophylaxis - child |
21,466 |
21,425 |
$797K |
| D2140 |
|
8,124 |
2,807 |
$435K |
| D0230 |
Intraoral - periapical each additional radiographic image |
101,263 |
16,493 |
$419K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,023 |
6,016 |
$375K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,168 |
2,116 |
$276K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,197 |
20,161 |
$232K |
| D0274 |
Bitewings - four radiographic images |
9,922 |
9,907 |
$209K |
| D0210 |
Intraoral - complete series of radiographic images |
3,369 |
3,362 |
$152K |
| D1110 |
Prophylaxis - adult |
1,675 |
1,674 |
$137K |
| D0220 |
Intraoral - periapical first radiographic image |
10,007 |
9,976 |
$117K |
| D1351 |
Sealant - per tooth |
4,475 |
918 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
1,956 |
1,950 |
$67K |
| D0330 |
Panoramic radiographic image |
2,309 |
2,297 |
$65K |
| D0350 |
|
6,572 |
2,854 |
$62K |
| D0340 |
|
1,134 |
1,132 |
$55K |
| D4341 |
|
790 |
205 |
$53K |
| D1320 |
|
3,703 |
3,701 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
789 |
523 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,702 |
2,698 |
$32K |
| D9430 |
|
570 |
564 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
204 |
203 |
$13K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
12 |
12 |
$9K |
| D4342 |
|
88 |
26 |
$4K |
| D0470 |
|
12 |
12 |
$881.25 |