| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
9,325 |
8,713 |
$842K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
223 |
218 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,000 |
587 |
$95K |
| D1110 |
Prophylaxis - adult |
1,148 |
1,136 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,563 |
1,537 |
$35K |
| D8680 |
|
74 |
54 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
835 |
824 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
220 |
153 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
328 |
259 |
$24K |
| D0274 |
Bitewings - four radiographic images |
793 |
778 |
$23K |
| D0330 |
Panoramic radiographic image |
387 |
378 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,400 |
1,356 |
$19K |
| D0340 |
|
381 |
373 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,551 |
1,160 |
$17K |
| D0470 |
|
382 |
373 |
$15K |
| D1206 |
Topical application of fluoride varnish |
1,036 |
1,022 |
$15K |
| D1120 |
Prophylaxis - child |
581 |
571 |
$14K |
| D4355 |
|
175 |
171 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
287 |
280 |
$9K |
| D0272 |
Bitewings - two radiographic images |
290 |
286 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
317 |
315 |
$5K |
| D2331 |
|
23 |
17 |
$2K |