| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
5,862 |
5,497 |
$509K |
| D1120 |
Prophylaxis - child |
13,058 |
12,500 |
$410K |
| D0120 |
Periodic oral evaluation - established patient |
13,580 |
13,008 |
$311K |
| D1206 |
Topical application of fluoride varnish |
15,176 |
14,520 |
$304K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,562 |
591 |
$252K |
| D0272 |
Bitewings - two radiographic images |
6,717 |
6,424 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,040 |
1,992 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,097 |
1,848 |
$57K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
77 |
70 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
598 |
286 |
$40K |
| D8660 |
|
616 |
600 |
$28K |
| D8680 |
|
129 |
105 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,779 |
1,652 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
197 |
80 |
$16K |
| D0330 |
Panoramic radiographic image |
312 |
289 |
$13K |
| D1110 |
Prophylaxis - adult |
118 |
108 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
27 |
$4K |
| D1351 |
Sealant - per tooth |
139 |
37 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
495 |
279 |
$4K |
| D9110 |
|
14 |
13 |
$564.64 |
| D9987 |
|
33 |
31 |
$0.00 |
| D1999 |
|
885 |
803 |
$0.00 |
| D9986 |
|
31 |
30 |
$0.00 |
| D9420 |
|
16 |
15 |
$0.00 |