| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,570 |
6,361 |
$351K |
| D8670 |
Periodic orthodontic treatment visit |
1,072 |
988 |
$241K |
| D0120 |
Periodic oral evaluation - established patient |
6,732 |
6,504 |
$163K |
| D0274 |
Bitewings - four radiographic images |
4,211 |
4,101 |
$153K |
| D0210 |
Intraoral - complete series of radiographic images |
1,475 |
1,418 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
2,767 |
2,583 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,474 |
3,322 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
5,343 |
5,034 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
937 |
585 |
$74K |
| D1120 |
Prophylaxis - child |
1,296 |
1,266 |
$64K |
| D4381 |
|
716 |
90 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
963 |
612 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
405 |
168 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,740 |
3,357 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
944 |
898 |
$37K |
| D1206 |
Topical application of fluoride varnish |
709 |
697 |
$19K |
| D0330 |
Panoramic radiographic image |
242 |
234 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
119 |
82 |
$8K |
| D8690 |
|
48 |
46 |
$6K |
| D4341 |
|
45 |
14 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
31 |
$4K |
| D9610 |
|
143 |
133 |
$4K |
| D1351 |
Sealant - per tooth |
97 |
24 |
$3K |
| D9910 |
|
128 |
120 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D2330 |
|
20 |
12 |
$1K |
| D8660 |
|
16 |
16 |
$403.00 |
| D0270 |
|
12 |
12 |
$155.00 |