| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
686 |
686 |
$801K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,570 |
237 |
$196K |
| D1110 |
Prophylaxis - adult |
2,512 |
2,438 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
3,427 |
3,338 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,592 |
1,537 |
$49K |
| D0330 |
Panoramic radiographic image |
886 |
873 |
$44K |
| D1320 |
|
1,277 |
1,277 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,596 |
2,596 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
264 |
167 |
$29K |
| D9310 |
|
468 |
462 |
$23K |
| D1120 |
Prophylaxis - child |
734 |
722 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
332 |
74 |
$22K |
| D0470 |
|
380 |
372 |
$14K |
| D1206 |
Topical application of fluoride varnish |
563 |
481 |
$10K |
| D5120 |
|
13 |
13 |
$10K |
| D5110 |
|
14 |
14 |
$10K |
| D0340 |
|
138 |
138 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
125 |
79 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
226 |
220 |
$7K |
| D2140 |
|
98 |
60 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
46 |
34 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
14 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
119 |
118 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
60 |
$2K |
| D0272 |
Bitewings - two radiographic images |
74 |
70 |
$1K |
| D1351 |
Sealant - per tooth |
45 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
26 |
$795.76 |
| D0350 |
|
12 |
12 |
$330.68 |