| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
13,000 |
11,447 |
$577K |
| D8670 |
Periodic orthodontic treatment visit |
5,819 |
5,232 |
$433K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,606 |
1,226 |
$254K |
| D1110 |
Prophylaxis - adult |
3,926 |
3,872 |
$240K |
| D0120 |
Periodic oral evaluation - established patient |
7,157 |
7,075 |
$213K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,600 |
978 |
$205K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,286 |
477 |
$191K |
| D1206 |
Topical application of fluoride varnish |
7,003 |
6,921 |
$174K |
| D1120 |
Prophylaxis - child |
3,717 |
3,675 |
$162K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,427 |
6,351 |
$147K |
| D9941 |
|
1,116 |
1,110 |
$115K |
| D1351 |
Sealant - per tooth |
3,061 |
653 |
$109K |
| D0274 |
Bitewings - four radiographic images |
2,649 |
2,625 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
860 |
845 |
$31K |
| D0330 |
Panoramic radiographic image |
684 |
677 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,473 |
1,422 |
$15K |
| D8660 |
|
77 |
75 |
$11K |
| D9940 |
|
72 |
72 |
$11K |
| D1330 |
|
1,598 |
1,583 |
$10K |
| D9944 |
|
56 |
55 |
$8K |
| D2330 |
|
97 |
64 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
127 |
127 |
$7K |
| D0272 |
Bitewings - two radiographic images |
457 |
451 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$2K |