| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
2,007 |
895 |
$2.77M |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,514 |
1,184 |
$556K |
| D4341 |
|
4,032 |
1,511 |
$373K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,530 |
1,404 |
$222K |
| D1110 |
Prophylaxis - adult |
5,098 |
5,003 |
$178K |
| D0210 |
Intraoral - complete series of radiographic images |
4,464 |
4,122 |
$172K |
| D1351 |
Sealant - per tooth |
7,471 |
757 |
$140K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,536 |
1,143 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,338 |
5,232 |
$117K |
| D0340 |
|
3,043 |
2,895 |
$116K |
| D0330 |
Panoramic radiographic image |
6,026 |
5,847 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,344 |
5,241 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,071 |
645 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
3,565 |
3,523 |
$62K |
| D0274 |
Bitewings - four radiographic images |
5,332 |
5,271 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
7,515 |
7,361 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,095 |
6,167 |
$37K |
| D9310 |
|
1,635 |
1,526 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,348 |
1,311 |
$32K |
| D1120 |
Prophylaxis - child |
1,036 |
1,020 |
$25K |
| D0470 |
|
725 |
709 |
$23K |
| D5214 |
|
27 |
27 |
$15K |
| D5213 |
|
25 |
25 |
$14K |
| D2954 |
|
143 |
118 |
$10K |
| D3310 |
|
36 |
27 |
$9K |
| D5110 |
|
12 |
12 |
$7K |
| D3320 |
|
12 |
12 |
$4K |
| D2331 |
|
21 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$189.09 |
| D1999 |
|
2,324 |
1,993 |
$0.00 |