| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,482 |
5,030 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
5,462 |
5,003 |
$142K |
| D8670 |
Periodic orthodontic treatment visit |
590 |
540 |
$130K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,850 |
6,242 |
$94K |
| D1351 |
Sealant - per tooth |
1,405 |
751 |
$84K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,075 |
2,765 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
857 |
471 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,912 |
1,773 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
6,924 |
6,376 |
$37K |
| D0272 |
Bitewings - two radiographic images |
4,373 |
4,082 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
409 |
234 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
2,635 |
2,357 |
$17K |
| D1206 |
Topical application of fluoride varnish |
528 |
513 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
244 |
184 |
$11K |
| D1110 |
Prophylaxis - adult |
215 |
197 |
$6K |
| D0274 |
Bitewings - four radiographic images |
202 |
163 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
28 |
$372.60 |