| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,924 |
3,713 |
$573K |
| D1120 |
Prophylaxis - child |
4,378 |
4,319 |
$229K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,888 |
6,771 |
$208K |
| D0120 |
Periodic oral evaluation - established patient |
4,718 |
4,632 |
$187K |
| D1110 |
Prophylaxis - adult |
2,438 |
2,388 |
$169K |
| D0272 |
Bitewings - two radiographic images |
2,922 |
2,867 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
547 |
382 |
$103K |
| D1351 |
Sealant - per tooth |
1,347 |
395 |
$59K |
| D0330 |
Panoramic radiographic image |
414 |
407 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
536 |
517 |
$34K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
77 |
56 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
138 |
131 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
30 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
32 |
24 |
$5K |
| D8660 |
|
29 |
29 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
39 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$2K |
| D0160 |
|
14 |
13 |
$2K |
| D0602 |
|
2,009 |
1,968 |
$0.00 |
| D0603 |
|
1,301 |
1,268 |
$0.00 |
| D0601 |
|
2,695 |
2,650 |
$0.00 |
| D1999 |
|
62 |
60 |
$0.00 |