| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,689 |
3,664 |
$1.47M |
| D1120 |
Prophylaxis - child |
22,616 |
22,491 |
$726K |
| D1206 |
Topical application of fluoride varnish |
34,478 |
34,288 |
$690K |
| D0120 |
Periodic oral evaluation - established patient |
29,721 |
29,550 |
$571K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
552 |
551 |
$569K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,295 |
1,795 |
$558K |
| D1110 |
Prophylaxis - adult |
10,361 |
10,291 |
$466K |
| D7240 |
Removal of impacted tooth - completely bony |
1,793 |
581 |
$429K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,208 |
20,824 |
$278K |
| D0220 |
Intraoral - periapical first radiographic image |
26,286 |
25,686 |
$277K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,618 |
1,787 |
$222K |
| D9630 |
|
11,333 |
11,304 |
$221K |
| D8660 |
|
996 |
984 |
$198K |
| D0272 |
Bitewings - two radiographic images |
10,095 |
10,037 |
$193K |
| D0274 |
Bitewings - four radiographic images |
7,233 |
7,179 |
$191K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,749 |
5,105 |
$190K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,663 |
6,499 |
$187K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,890 |
1,583 |
$186K |
| D1351 |
Sealant - per tooth |
4,288 |
1,310 |
$132K |
| D0330 |
Panoramic radiographic image |
2,053 |
1,926 |
$97K |
| D0140 |
Limited oral evaluation - problem focused |
3,466 |
3,222 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
993 |
742 |
$70K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
547 |
313 |
$65K |
| D8680 |
|
122 |
121 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
266 |
191 |
$7K |
| D7230 |
|
23 |
15 |
$4K |
| D7220 |
|
22 |
12 |
$3K |
| D9420 |
|
25 |
25 |
$2K |
| D3120 |
|
51 |
39 |
$938.91 |
| D0270 |
|
49 |
49 |
$57.08 |