| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
6,202 |
5,928 |
$285K |
| D8670 |
Periodic orthodontic treatment visit |
835 |
834 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
4,904 |
4,854 |
$154K |
| D1110 |
Prophylaxis - adult |
3,079 |
3,050 |
$151K |
| D1206 |
Topical application of fluoride varnish |
5,214 |
5,168 |
$131K |
| D0140 |
Limited oral evaluation - problem focused |
3,787 |
3,520 |
$125K |
| D1120 |
Prophylaxis - child |
2,989 |
2,967 |
$103K |
| D0330 |
Panoramic radiographic image |
1,067 |
1,061 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,620 |
1,609 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
737 |
219 |
$56K |
| D0272 |
Bitewings - two radiographic images |
962 |
958 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,805 |
1,764 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
822 |
816 |
$28K |
| D1330 |
|
1,668 |
1,651 |
$23K |
| D9920 |
|
655 |
625 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,309 |
514 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
893 |
861 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
171 |
95 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
240 |
138 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
48 |
$5K |
| D2331 |
|
20 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
48 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
31 |
$347.62 |
| D9985 |
|
71 |
63 |
$0.00 |