| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
14,087 |
13,161 |
$3.78M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
2,179 |
2,071 |
$1.32M |
| D8680 |
|
4,766 |
2,120 |
$882K |
| D8030 |
|
12,454 |
12,193 |
$559K |
| D1110 |
Prophylaxis - adult |
14,642 |
13,228 |
$494K |
| D0330 |
Panoramic radiographic image |
12,520 |
11,189 |
$473K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,806 |
3,586 |
$458K |
| D0340 |
|
5,895 |
5,433 |
$342K |
| D1351 |
Sealant - per tooth |
12,225 |
2,547 |
$302K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,299 |
2,924 |
$301K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,698 |
10,571 |
$293K |
| D9944 |
|
931 |
878 |
$282K |
| D2335 |
|
1,958 |
961 |
$270K |
| D0274 |
Bitewings - four radiographic images |
12,888 |
11,621 |
$227K |
| D0120 |
Periodic oral evaluation - established patient |
13,804 |
12,472 |
$217K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,216 |
1,923 |
$208K |
| D2332 |
|
2,446 |
861 |
$207K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,778 |
1,640 |
$202K |
| D0470 |
|
11,372 |
6,870 |
$190K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,005 |
11,853 |
$187K |
| D2330 |
|
2,090 |
974 |
$119K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
163 |
147 |
$118K |
| D2394 |
|
1,007 |
595 |
$108K |
| D0350 |
|
11,926 |
8,247 |
$108K |
| D1120 |
Prophylaxis - child |
5,441 |
4,840 |
$95K |
| D0140 |
Limited oral evaluation - problem focused |
4,110 |
3,503 |
$66K |
| D2331 |
|
636 |
371 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
1,087 |
1,029 |
$43K |
| D0272 |
Bitewings - two radiographic images |
5,100 |
4,620 |
$43K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
443 |
206 |
$23K |
| D3320 |
|
34 |
30 |
$20K |
| D2160 |
|
293 |
135 |
$19K |
| D4211 |
|
298 |
159 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,727 |
2,046 |
$9K |
| D2140 |
|
178 |
104 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,097 |
550 |
$5K |
| D0240 |
|
405 |
207 |
$2K |
| D1206 |
Topical application of fluoride varnish |
68 |
60 |
$120.00 |