| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,746 |
7,252 |
$305K |
| D0120 |
Periodic oral evaluation - established patient |
8,055 |
7,561 |
$213K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,223 |
4,886 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,667 |
1,310 |
$107K |
| D8670 |
Periodic orthodontic treatment visit |
399 |
376 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,929 |
1,544 |
$88K |
| D1351 |
Sealant - per tooth |
1,212 |
842 |
$79K |
| D9110 |
|
1,003 |
893 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
8,547 |
7,891 |
$46K |
| D0272 |
Bitewings - two radiographic images |
4,362 |
4,045 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,640 |
7,099 |
$30K |
| D1110 |
Prophylaxis - adult |
848 |
786 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,328 |
1,224 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
419 |
366 |
$21K |
| D8999 |
|
500 |
455 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
229 |
185 |
$14K |
| D1206 |
Topical application of fluoride varnish |
436 |
415 |
$11K |
| D0270 |
|
2,011 |
1,897 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
506 |
481 |
$8K |
| D4342 |
|
32 |
25 |
$6K |
| D4341 |
|
16 |
13 |
$3K |
| D0330 |
Panoramic radiographic image |
152 |
139 |
$3K |
| D0274 |
Bitewings - four radiographic images |
145 |
141 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
32 |
26 |
$2K |
| D8660 |
|
14 |
13 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
12 |
12 |
$631.40 |