| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,197 |
2,186 |
$541K |
| D0120 |
Periodic oral evaluation - established patient |
6,339 |
6,339 |
$130K |
| D1120 |
Prophylaxis - child |
3,883 |
3,883 |
$118K |
| D1110 |
Prophylaxis - adult |
2,815 |
2,815 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,761 |
1,008 |
$91K |
| D0274 |
Bitewings - four radiographic images |
4,089 |
4,089 |
$84K |
| D1351 |
Sealant - per tooth |
2,559 |
845 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,968 |
4,968 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,392 |
4,390 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,163 |
764 |
$39K |
| D0340 |
|
730 |
730 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,555 |
5,553 |
$34K |
| D8660 |
|
1,023 |
1,023 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,239 |
1,239 |
$27K |
| D0330 |
Panoramic radiographic image |
681 |
681 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,258 |
1,257 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
196 |
122 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
405 |
285 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
392 |
392 |
$9K |
| D0470 |
|
239 |
239 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
207 |
203 |
$6K |
| D0350 |
|
529 |
529 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
49 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
84 |
84 |
$3K |
| D1354 |
|
195 |
53 |
$3K |