| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,654 |
2,595 |
$729K |
| D2740 |
Crown - porcelain/ceramic |
188 |
123 |
$131K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
109 |
104 |
$131K |
| D1110 |
Prophylaxis - adult |
1,934 |
1,844 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,105 |
600 |
$108K |
| D0274 |
Bitewings - four radiographic images |
2,149 |
2,074 |
$84K |
| D9310 |
|
1,388 |
1,368 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,666 |
2,586 |
$71K |
| D1120 |
Prophylaxis - child |
1,219 |
1,192 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,492 |
1,402 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,908 |
1,868 |
$57K |
| D8660 |
|
542 |
533 |
$41K |
| D8680 |
|
358 |
355 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
471 |
457 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
295 |
175 |
$22K |
| D1351 |
Sealant - per tooth |
468 |
115 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
738 |
700 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
58 |
31 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
49 |
$9K |
| D0272 |
Bitewings - two radiographic images |
225 |
223 |
$7K |
| D0330 |
Panoramic radiographic image |
102 |
97 |
$7K |
| D7311 |
|
22 |
12 |
$3K |
| D2950 |
|
13 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
15 |
$278.00 |