| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,237 |
2,220 |
$93K |
| D1110 |
Prophylaxis - adult |
1,457 |
1,449 |
$77K |
| D8670 |
Periodic orthodontic treatment visit |
1,118 |
1,109 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
3,164 |
3,149 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
782 |
555 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
504 |
492 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
133 |
110 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,318 |
2,280 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
307 |
231 |
$14K |
| D1351 |
Sealant - per tooth |
801 |
261 |
$10K |
| D8660 |
|
213 |
184 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
32 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
204 |
196 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
34 |
$3K |
| D0330 |
Panoramic radiographic image |
64 |
64 |
$1K |
| D3120 |
|
1,101 |
648 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
180 |
170 |
$933.88 |
| D0220 |
Intraoral - periapical first radiographic image |
2,449 |
2,423 |
$841.00 |
| D7111 |
|
19 |
13 |
$744.06 |
| D0274 |
Bitewings - four radiographic images |
1,286 |
1,280 |
$704.20 |
| D0272 |
Bitewings - two radiographic images |
1,651 |
1,635 |
$655.80 |
| D0240 |
|
1,142 |
1,107 |
$274.46 |
| D1330 |
|
3,769 |
3,741 |
$263.77 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,379 |
2,367 |
$193.77 |
| D1206 |
Topical application of fluoride varnish |
1,332 |
1,321 |
$0.00 |