| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,526 |
1,389 |
$269K |
| D1120 |
Prophylaxis - child |
5,004 |
4,897 |
$241K |
| D1110 |
Prophylaxis - adult |
4,524 |
4,345 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
7,760 |
7,542 |
$196K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,366 |
6,199 |
$177K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,183 |
680 |
$101K |
| D0274 |
Bitewings - four radiographic images |
2,340 |
2,277 |
$86K |
| D0140 |
Limited oral evaluation - problem focused |
2,019 |
1,892 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,450 |
1,409 |
$64K |
| D1351 |
Sealant - per tooth |
1,009 |
251 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
581 |
325 |
$38K |
| D2740 |
Crown - porcelain/ceramic |
66 |
33 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
264 |
252 |
$18K |
| D0330 |
Panoramic radiographic image |
294 |
289 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
909 |
829 |
$13K |
| D8660 |
|
523 |
507 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
47 |
$5K |
| D9310 |
|
85 |
68 |
$4K |
| D0272 |
Bitewings - two radiographic images |
105 |
104 |
$3K |
| D8690 |
|
19 |
19 |
$2K |
| D0270 |
|
25 |
25 |
$327.00 |