| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
6,352 |
5,997 |
$1.57M |
| D9920 |
|
13,263 |
11,449 |
$931K |
| D1110 |
Prophylaxis - adult |
12,547 |
11,352 |
$704K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
458 |
433 |
$518K |
| D1206 |
Topical application of fluoride varnish |
13,456 |
12,235 |
$373K |
| D0120 |
Periodic oral evaluation - established patient |
8,686 |
7,815 |
$189K |
| D8680 |
|
2,082 |
1,925 |
$185K |
| D0330 |
Panoramic radiographic image |
1,652 |
1,598 |
$128K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,339 |
602 |
$115K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,321 |
797 |
$112K |
| D4341 |
|
540 |
204 |
$93K |
| D9248 |
|
2,297 |
1,977 |
$92K |
| D0274 |
Bitewings - four radiographic images |
2,131 |
1,893 |
$73K |
| D9310 |
|
1,095 |
1,016 |
$56K |
| D1120 |
Prophylaxis - child |
930 |
909 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
643 |
621 |
$51K |
| D0180 |
|
719 |
698 |
$25K |
| D8690 |
|
199 |
188 |
$24K |
| D8999 |
|
432 |
395 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
261 |
142 |
$16K |
| D9110 |
|
388 |
363 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
267 |
258 |
$13K |
| D2140 |
|
187 |
100 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
56 |
12 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
234 |
223 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
13 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
422 |
330 |
$6K |
| D2160 |
|
36 |
27 |
$3K |
| D8660 |
|
45 |
42 |
$3K |
| D2330 |
|
25 |
13 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
108 |
31 |
$929.00 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$664.00 |