| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
14,170 |
14,130 |
$2.18M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,322 |
1,208 |
$1.39M |
| D1110 |
Prophylaxis - adult |
12,702 |
12,078 |
$489K |
| D0120 |
Periodic oral evaluation - established patient |
17,995 |
17,109 |
$430K |
| D2722 |
|
716 |
328 |
$340K |
| D1206 |
Topical application of fluoride varnish |
16,171 |
15,354 |
$309K |
| D0330 |
Panoramic radiographic image |
5,709 |
5,436 |
$300K |
| D5226 |
|
359 |
342 |
$281K |
| D1351 |
Sealant - per tooth |
13,719 |
2,120 |
$268K |
| D0274 |
Bitewings - four radiographic images |
9,465 |
8,970 |
$260K |
| D0340 |
|
3,245 |
2,991 |
$216K |
| D5225 |
|
257 |
252 |
$210K |
| D0350 |
|
3,839 |
3,585 |
$193K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,087 |
1,616 |
$181K |
| D1120 |
Prophylaxis - child |
5,478 |
5,230 |
$143K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,107 |
1,082 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,495 |
1,255 |
$99K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,643 |
964 |
$98K |
| D0220 |
Intraoral - periapical first radiographic image |
6,864 |
5,956 |
$78K |
| D2335 |
|
870 |
553 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
2,231 |
2,152 |
$62K |
| D7111 |
|
1,001 |
586 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
819 |
551 |
$57K |
| D2331 |
|
808 |
543 |
$55K |
| D2330 |
|
1,070 |
477 |
$51K |
| D2160 |
|
683 |
472 |
$50K |
| D3320 |
|
172 |
128 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,070 |
1,953 |
$45K |
| D2140 |
|
1,149 |
530 |
$44K |
| D2332 |
|
515 |
340 |
$44K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
324 |
230 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,073 |
1,985 |
$26K |
| D8660 |
|
2,177 |
1,904 |
$23K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
78 |
56 |
$21K |
| D8703 |
|
59 |
58 |
$17K |
| D8704 |
|
55 |
55 |
$16K |
| D7250 |
|
153 |
94 |
$16K |
| D3310 |
|
76 |
54 |
$14K |
| D2161 |
|
75 |
52 |
$7K |
| D4355 |
|
139 |
113 |
$5K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
117 |
97 |
$3K |
| D2394 |
|
35 |
27 |
$2K |
| D3240 |
|
28 |
18 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
20 |
20 |
$785.80 |