| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
275 |
146 |
$466K |
| D0210 |
Intraoral - complete series of radiographic images |
1,406 |
1,193 |
$50K |
| D1110 |
Prophylaxis - adult |
1,249 |
1,200 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
545 |
216 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,601 |
1,549 |
$35K |
| D0340 |
|
703 |
683 |
$29K |
| D0330 |
Panoramic radiographic image |
2,016 |
1,966 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,183 |
1,123 |
$16K |
| D9310 |
|
584 |
564 |
$14K |
| D0470 |
|
341 |
336 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
223 |
121 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
293 |
288 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,365 |
1,317 |
$7K |
| D0274 |
Bitewings - four radiographic images |
792 |
757 |
$6K |
| D1351 |
Sealant - per tooth |
240 |
23 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,720 |
843 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
211 |
195 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
24 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
15 |
$2K |
| D1330 |
|
41 |
41 |
$0.00 |
| D1999 |
|
554 |
512 |
$0.00 |