| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
8,136 |
7,497 |
$645K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,632 |
2,287 |
$457K |
| D0120 |
Periodic oral evaluation - established patient |
11,636 |
10,987 |
$276K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
415 |
316 |
$248K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,601 |
1,419 |
$190K |
| D1120 |
Prophylaxis - child |
7,240 |
6,853 |
$183K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,016 |
10,410 |
$168K |
| D1110 |
Prophylaxis - adult |
4,647 |
4,356 |
$164K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,257 |
651 |
$149K |
| D1351 |
Sealant - per tooth |
5,341 |
1,448 |
$142K |
| D0140 |
Limited oral evaluation - problem focused |
4,082 |
3,769 |
$138K |
| D0330 |
Panoramic radiographic image |
3,105 |
2,861 |
$136K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,935 |
7,619 |
$129K |
| D0220 |
Intraoral - periapical first radiographic image |
9,205 |
8,550 |
$126K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,081 |
906 |
$125K |
| D0274 |
Bitewings - four radiographic images |
3,532 |
3,292 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,625 |
1,497 |
$63K |
| D0272 |
Bitewings - two radiographic images |
3,607 |
3,400 |
$60K |
| D2394 |
|
161 |
68 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
178 |
86 |
$16K |
| D0340 |
|
343 |
286 |
$14K |
| D4355 |
|
175 |
161 |
$11K |
| D0470 |
|
335 |
284 |
$11K |
| D7240 |
Removal of impacted tooth - completely bony |
36 |
12 |
$6K |
| D9239 |
|
77 |
62 |
$4K |
| D4341 |
|
62 |
25 |
$4K |
| D9243 |
|
62 |
44 |
$4K |
| D9612 |
|
75 |
61 |
$3K |