| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
17,882 |
16,387 |
$2.38M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
944 |
855 |
$1.04M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,975 |
6,561 |
$794K |
| D0330 |
Panoramic radiographic image |
14,275 |
13,012 |
$749K |
| D0140 |
Limited oral evaluation - problem focused |
17,679 |
16,088 |
$574K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,066 |
3,528 |
$569K |
| D1110 |
Prophylaxis - adult |
14,920 |
14,054 |
$542K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,570 |
4,630 |
$464K |
| D1351 |
Sealant - per tooth |
15,874 |
2,497 |
$461K |
| D0220 |
Intraoral - periapical first radiographic image |
30,024 |
27,428 |
$404K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,262 |
12,046 |
$378K |
| D0120 |
Periodic oral evaluation - established patient |
15,088 |
14,325 |
$349K |
| D0274 |
Bitewings - four radiographic images |
14,271 |
13,249 |
$345K |
| D1120 |
Prophylaxis - child |
10,063 |
9,430 |
$329K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,598 |
16,727 |
$308K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,996 |
21,250 |
$297K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,793 |
2,003 |
$241K |
| D0470 |
|
4,191 |
3,914 |
$224K |
| D0340 |
|
5,439 |
5,081 |
$215K |
| D0350 |
|
5,617 |
5,254 |
$182K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,142 |
680 |
$160K |
| D0210 |
Intraoral - complete series of radiographic images |
4,428 |
3,748 |
$155K |
| D8680 |
|
516 |
462 |
$111K |
| D1206 |
Topical application of fluoride varnish |
4,489 |
4,128 |
$91K |
| D9110 |
|
1,212 |
1,053 |
$61K |
| D2394 |
|
660 |
463 |
$55K |
| D8660 |
|
540 |
523 |
$44K |
| D4355 |
|
677 |
599 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,522 |
1,453 |
$34K |
| D2335 |
|
494 |
278 |
$33K |
| D5110 |
|
56 |
44 |
$19K |
| D2940 |
|
485 |
291 |
$16K |
| D2331 |
|
304 |
214 |
$15K |
| D2332 |
|
252 |
141 |
$13K |
| D2330 |
|
196 |
114 |
$8K |
| D7230 |
|
25 |
12 |
$6K |
| D5120 |
|
18 |
14 |
$6K |
| D0191 |
|
668 |
572 |
$4K |
| D5212 |
|
14 |
13 |
$3K |
| D4341 |
|
26 |
12 |
$2K |
| D9610 |
|
64 |
55 |
$1K |
| D0270 |
|
80 |
79 |
$898.20 |
| D0170 |
|
57 |
47 |
$777.13 |
| D1999 |
|
2,249 |
1,685 |
$0.00 |
| D0180 |
|
12 |
12 |
$0.00 |