| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,647 |
5,445 |
$226K |
| D0120 |
Periodic oral evaluation - established patient |
6,319 |
6,094 |
$173K |
| D8670 |
Periodic orthodontic treatment visit |
576 |
553 |
$132K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,935 |
4,784 |
$127K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,591 |
1,263 |
$109K |
| D1351 |
Sealant - per tooth |
767 |
425 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
7,676 |
7,345 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
900 |
722 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,153 |
6,852 |
$29K |
| D4341 |
|
159 |
98 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,456 |
1,446 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,099 |
1,065 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,598 |
2,473 |
$25K |
| D1110 |
Prophylaxis - adult |
546 |
531 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
230 |
199 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
276 |
235 |
$14K |
| D0270 |
|
2,290 |
2,213 |
$13K |
| D9110 |
|
225 |
211 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
609 |
583 |
$10K |
| D8999 |
|
274 |
234 |
$10K |