| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
15,058 |
14,267 |
$358K |
| D1120 |
Prophylaxis - child |
9,163 |
8,756 |
$230K |
| D8670 |
Periodic orthodontic treatment visit |
2,528 |
2,192 |
$197K |
| D1110 |
Prophylaxis - adult |
5,587 |
5,249 |
$192K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,938 |
8,518 |
$137K |
| D1206 |
Topical application of fluoride varnish |
5,973 |
5,438 |
$82K |
| D0272 |
Bitewings - two radiographic images |
4,037 |
3,844 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,624 |
1,523 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
437 |
237 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
608 |
537 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
295 |
174 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,482 |
1,395 |
$21K |
| D0330 |
Panoramic radiographic image |
332 |
318 |
$13K |
| D1351 |
Sealant - per tooth |
346 |
121 |
$8K |
| D1354 |
|
92 |
43 |
$346.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
12 |
$139.64 |