| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,326 |
2,188 |
$510K |
| D1120 |
Prophylaxis - child |
10,376 |
9,948 |
$422K |
| D1351 |
Sealant - per tooth |
4,728 |
2,318 |
$353K |
| D0120 |
Periodic oral evaluation - established patient |
9,456 |
9,081 |
$264K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,711 |
9,339 |
$251K |
| D0330 |
Panoramic radiographic image |
1,779 |
1,715 |
$39K |
| D0274 |
Bitewings - four radiographic images |
2,096 |
2,036 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
446 |
370 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
913 |
883 |
$21K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
13 |
13 |
$12K |
| D8680 |
|
71 |
66 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
63 |
$5K |
| D2140 |
|
103 |
98 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
50 |
$4K |
| D0272 |
Bitewings - two radiographic images |
323 |
308 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
124 |
124 |
$3K |
| D9310 |
|
122 |
117 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
26 |
$2K |
| D2160 |
|
19 |
14 |
$1K |
| D1110 |
Prophylaxis - adult |
27 |
27 |
$1K |
| D8660 |
|
13 |
12 |
$943.20 |