| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,192 |
2,884 |
$776K |
| D1110 |
Prophylaxis - adult |
8,497 |
8,223 |
$433K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
356 |
307 |
$239K |
| D0120 |
Periodic oral evaluation - established patient |
9,400 |
9,129 |
$220K |
| D0140 |
Limited oral evaluation - problem focused |
3,257 |
3,138 |
$126K |
| D2740 |
Crown - porcelain/ceramic |
162 |
107 |
$107K |
| D1120 |
Prophylaxis - child |
1,819 |
1,773 |
$90K |
| D0274 |
Bitewings - four radiographic images |
2,469 |
2,385 |
$84K |
| D1206 |
Topical application of fluoride varnish |
2,269 |
2,207 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
737 |
424 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,958 |
1,930 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
790 |
758 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,232 |
1,188 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
617 |
300 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,806 |
2,689 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
284 |
176 |
$41K |
| D8680 |
|
380 |
335 |
$32K |
| D9310 |
|
541 |
424 |
$21K |
| D8660 |
|
589 |
572 |
$18K |
| D1351 |
Sealant - per tooth |
372 |
80 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
14 |
$10K |
| D8690 |
|
53 |
51 |
$7K |
| D0330 |
Panoramic radiographic image |
54 |
52 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
27 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$2K |
| D0270 |
|
102 |
96 |
$886.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
57 |
43 |
$657.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
13 |
$345.17 |
| D1999 |
|
74 |
67 |
$0.00 |