| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
268 |
266 |
$300K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,072 |
737 |
$121K |
| D1110 |
Prophylaxis - adult |
2,184 |
2,132 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
4,168 |
4,049 |
$89K |
| D1120 |
Prophylaxis - child |
2,349 |
2,281 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,567 |
4,443 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,190 |
2,088 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,659 |
1,621 |
$51K |
| D3120 |
|
1,658 |
956 |
$50K |
| D0330 |
Panoramic radiographic image |
569 |
559 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
220 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
77 |
$6K |
| D0340 |
|
72 |
72 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
201 |
198 |
$3K |
| D0470 |
|
53 |
53 |
$2K |
| D9310 |
|
39 |
39 |
$2K |
| D7111 |
|
16 |
12 |
$975.68 |
| D1351 |
Sealant - per tooth |
36 |
13 |
$878.40 |
| D0272 |
Bitewings - two radiographic images |
42 |
42 |
$768.30 |
| D0603 |
|
42 |
42 |
$384.30 |
| D0230 |
Intraoral - periapical each additional radiographic image |
46 |
24 |
$350.52 |
| D0602 |
|
25 |
25 |
$228.75 |