| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
387 |
380 |
$141K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,048 |
1,162 |
$133K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,987 |
1,004 |
$113K |
| D1110 |
Prophylaxis - adult |
3,282 |
3,195 |
$112K |
| D1120 |
Prophylaxis - child |
2,541 |
2,527 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,632 |
3,030 |
$71K |
| D0274 |
Bitewings - four radiographic images |
3,728 |
3,641 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,847 |
3,816 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
3,964 |
3,905 |
$65K |
| D0330 |
Panoramic radiographic image |
1,874 |
1,347 |
$62K |
| D9630 |
|
3,600 |
3,576 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
5,451 |
4,550 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,563 |
3,330 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,945 |
1,576 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
482 |
176 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
2,209 |
1,430 |
$25K |
| D8660 |
|
139 |
138 |
$19K |
| D1351 |
Sealant - per tooth |
643 |
200 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
193 |
91 |
$12K |
| D2950 |
|
111 |
95 |
$4K |
| D1206 |
Topical application of fluoride varnish |
50 |
50 |
$436.59 |
| D4341 |
|
121 |
44 |
$0.00 |
| D7880 |
|
12 |
12 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
27 |
$0.00 |
| D9994 |
|
978 |
977 |
$0.00 |