| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,041 |
4,030 |
$213K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,803 |
4,790 |
$143K |
| D0140 |
Limited oral evaluation - problem focused |
2,315 |
2,282 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
3,626 |
3,619 |
$109K |
| D8670 |
Periodic orthodontic treatment visit |
362 |
357 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
461 |
461 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,278 |
1,237 |
$26K |
| D0272 |
Bitewings - two radiographic images |
816 |
815 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
186 |
100 |
$22K |
| D1351 |
Sealant - per tooth |
449 |
127 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
555 |
362 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
81 |
49 |
$8K |
| D9110 |
|
99 |
98 |
$7K |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$5K |
| D1110 |
Prophylaxis - adult |
44 |
44 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
30 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
49 |
49 |
$2K |
| D9310 |
|
22 |
20 |
$1K |