| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,981 |
5,668 |
$153K |
| D1110 |
Prophylaxis - adult |
2,917 |
2,759 |
$133K |
| D0272 |
Bitewings - two radiographic images |
4,735 |
4,514 |
$106K |
| D1120 |
Prophylaxis - child |
3,107 |
2,943 |
$105K |
| D1206 |
Topical application of fluoride varnish |
4,524 |
4,449 |
$87K |
| D8670 |
Periodic orthodontic treatment visit |
459 |
217 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
544 |
330 |
$43K |
| D1351 |
Sealant - per tooth |
1,425 |
496 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
340 |
323 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,134 |
915 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,248 |
1,153 |
$21K |
| D2140 |
|
323 |
193 |
$20K |
| D0602 |
|
1,800 |
1,779 |
$9K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
29 |
21 |
$7K |
| D0330 |
Panoramic radiographic image |
211 |
194 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
188 |
161 |
$6K |
| D0601 |
|
754 |
750 |
$4K |
| D0603 |
|
394 |
391 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
13 |
$1K |
| D1320 |
|
45 |
45 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$156.75 |