| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
28,541 |
22,718 |
$2.61M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
2,269 |
1,722 |
$1.78M |
| D1110 |
Prophylaxis - adult |
10,644 |
8,876 |
$258K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,946 |
11,270 |
$235K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,330 |
2,747 |
$216K |
| D0330 |
Panoramic radiographic image |
7,097 |
5,834 |
$215K |
| D1120 |
Prophylaxis - child |
11,103 |
9,148 |
$211K |
| D1351 |
Sealant - per tooth |
10,527 |
1,454 |
$188K |
| D0274 |
Bitewings - four radiographic images |
13,494 |
11,069 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
10,950 |
9,170 |
$151K |
| D8680 |
|
790 |
598 |
$147K |
| D1206 |
Topical application of fluoride varnish |
13,357 |
11,376 |
$146K |
| D0220 |
Intraoral - periapical first radiographic image |
23,285 |
18,822 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,475 |
1,978 |
$129K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,633 |
16,880 |
$105K |
| D0470 |
|
3,199 |
2,656 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,513 |
1,595 |
$95K |
| D0340 |
|
3,362 |
2,857 |
$94K |
| D0350 |
|
4,367 |
3,649 |
$91K |
| D8660 |
|
1,791 |
1,377 |
$81K |
| D0272 |
Bitewings - two radiographic images |
6,914 |
5,633 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
4,372 |
3,543 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,011 |
1,503 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
359 |
222 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
424 |
254 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
493 |
387 |
$15K |
| D4355 |
|
309 |
237 |
$13K |
| D7111 |
|
277 |
160 |
$13K |
| D2335 |
|
35 |
25 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
14 |
$818.80 |
| D9110 |
|
19 |
19 |
$385.25 |
| D0270 |
|
65 |
52 |
$322.34 |
| D1999 |
|
1,700 |
1,282 |
$0.00 |