| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,933 |
3,691 |
$336K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,275 |
918 |
$206K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,497 |
2,068 |
$86K |
| D1110 |
Prophylaxis - adult |
2,190 |
1,900 |
$71K |
| D0330 |
Panoramic radiographic image |
1,985 |
1,629 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,635 |
2,213 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
493 |
246 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,219 |
1,950 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,183 |
2,645 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,645 |
3,047 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,254 |
1,062 |
$40K |
| D1120 |
Prophylaxis - child |
858 |
729 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
246 |
135 |
$17K |
| D1206 |
Topical application of fluoride varnish |
873 |
767 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
687 |
577 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
29 |
13 |
$3K |
| D0340 |
|
35 |
25 |
$1K |
| D0470 |
|
34 |
24 |
$916.87 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18 |
14 |
$799.92 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$251.55 |