| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,915 |
2,841 |
$772K |
| D1120 |
Prophylaxis - child |
13,094 |
12,999 |
$682K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,418 |
17,288 |
$515K |
| D0120 |
Periodic oral evaluation - established patient |
16,365 |
16,238 |
$483K |
| D1110 |
Prophylaxis - adult |
4,202 |
4,166 |
$293K |
| D0210 |
Intraoral - complete series of radiographic images |
1,078 |
1,074 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
786 |
588 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,053 |
2,951 |
$63K |
| D0272 |
Bitewings - two radiographic images |
1,933 |
1,916 |
$59K |
| D8680 |
|
495 |
485 |
$47K |
| D0274 |
Bitewings - four radiographic images |
719 |
711 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
442 |
439 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
36 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
64 |
49 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
196 |
196 |
$4K |
| D9110 |
|
51 |
50 |
$4K |
| D9310 |
|
45 |
45 |
$3K |
| D8690 |
|
29 |
28 |
$816.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$204.00 |