| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,376 |
6,260 |
$342K |
| D8670 |
Periodic orthodontic treatment visit |
952 |
919 |
$258K |
| D1206 |
Topical application of fluoride varnish |
8,483 |
8,328 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
7,591 |
7,465 |
$231K |
| D1110 |
Prophylaxis - adult |
2,129 |
2,091 |
$155K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,201 |
831 |
$126K |
| D1351 |
Sealant - per tooth |
2,615 |
714 |
$110K |
| D2140 |
|
1,303 |
1,070 |
$98K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,031 |
916 |
$95K |
| D0272 |
Bitewings - two radiographic images |
2,181 |
2,120 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
824 |
821 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,116 |
1,097 |
$50K |
| D9110 |
|
654 |
631 |
$48K |
| D0330 |
Panoramic radiographic image |
546 |
511 |
$35K |
| D2330 |
|
240 |
168 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
99 |
28 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
184 |
142 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
694 |
666 |
$14K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
115 |
29 |
$12K |
| D8680 |
|
91 |
82 |
$8K |
| D2331 |
|
39 |
29 |
$5K |
| D8660 |
|
24 |
24 |
$3K |
| D9222 |
|
31 |
29 |
$3K |
| D9310 |
|
31 |
28 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
12 |
$578.00 |