| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,989 |
2,898 |
$745K |
| D1120 |
Prophylaxis - child |
14,413 |
14,296 |
$733K |
| D0120 |
Periodic oral evaluation - established patient |
18,442 |
18,300 |
$527K |
| D1206 |
Topical application of fluoride varnish |
19,051 |
18,852 |
$494K |
| D1351 |
Sealant - per tooth |
11,634 |
3,544 |
$476K |
| D1110 |
Prophylaxis - adult |
6,977 |
6,925 |
$440K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,895 |
2,989 |
$393K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,796 |
2,237 |
$383K |
| D0274 |
Bitewings - four radiographic images |
6,415 |
6,386 |
$266K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
169 |
167 |
$194K |
| D0272 |
Bitewings - two radiographic images |
6,122 |
6,106 |
$185K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
854 |
457 |
$170K |
| D0330 |
Panoramic radiographic image |
3,911 |
3,848 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,998 |
2,974 |
$141K |
| D2740 |
Crown - porcelain/ceramic |
191 |
124 |
$126K |
| D0220 |
Intraoral - periapical first radiographic image |
6,204 |
6,021 |
$114K |
| D0140 |
Limited oral evaluation - problem focused |
2,108 |
2,063 |
$89K |
| D8690 |
|
646 |
646 |
$83K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
537 |
306 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
641 |
413 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,472 |
3,054 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
379 |
240 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
518 |
509 |
$33K |
| D7111 |
|
339 |
216 |
$25K |
| D8660 |
|
139 |
137 |
$17K |
| D8680 |
|
167 |
149 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
515 |
462 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
113 |
69 |
$10K |
| D3120 |
|
154 |
100 |
$6K |
| D2140 |
|
60 |
39 |
$4K |
| D9945 |
|
13 |
13 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
152 |
151 |
$4K |
| D2394 |
|
26 |
15 |
$3K |
| D8999 |
|
13 |
12 |
$702.00 |
| D0270 |
|
40 |
39 |
$543.00 |
| D1999 |
|
3,859 |
3,538 |
$0.00 |