| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,078 |
958 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
439 |
232 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,244 |
1,218 |
$27K |
| D1110 |
Prophylaxis - adult |
520 |
516 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
881 |
873 |
$16K |
| D1120 |
Prophylaxis - child |
536 |
530 |
$15K |
| D0274 |
Bitewings - four radiographic images |
461 |
457 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
356 |
322 |
$12K |
| D1351 |
Sealant - per tooth |
292 |
43 |
$8K |
| D0601 |
|
475 |
471 |
$4K |
| D0272 |
Bitewings - two radiographic images |
256 |
254 |
$4K |
| D8660 |
|
27 |
27 |
$3K |
| D0330 |
Panoramic radiographic image |
77 |
77 |
$3K |
| D1330 |
|
537 |
532 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
27 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
91 |
90 |
$2K |
| D9110 |
|
56 |
56 |
$2K |
| D1310 |
|
308 |
306 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
15 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
16 |
$1K |