| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,322 |
17,190 |
$878K |
| D8670 |
Periodic orthodontic treatment visit |
3,032 |
2,814 |
$723K |
| D1206 |
Topical application of fluoride varnish |
25,262 |
24,844 |
$646K |
| D0120 |
Periodic oral evaluation - established patient |
23,168 |
22,860 |
$638K |
| D1110 |
Prophylaxis - adult |
8,786 |
8,556 |
$518K |
| D1351 |
Sealant - per tooth |
8,276 |
2,866 |
$331K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,969 |
1,880 |
$329K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,150 |
1,092 |
$186K |
| D0272 |
Bitewings - two radiographic images |
6,112 |
6,056 |
$181K |
| D0330 |
Panoramic radiographic image |
2,348 |
2,291 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,997 |
1,357 |
$173K |
| D0274 |
Bitewings - four radiographic images |
3,955 |
3,887 |
$161K |
| D9920 |
|
2,271 |
1,991 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,525 |
862 |
$143K |
| D0140 |
Limited oral evaluation - problem focused |
2,288 |
2,181 |
$97K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
446 |
140 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,157 |
1,150 |
$67K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
49 |
48 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,211 |
3,017 |
$57K |
| D8680 |
|
530 |
490 |
$49K |
| D0145 |
Oral evaluation for a patient under three years of age |
720 |
715 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,422 |
822 |
$17K |
| D8690 |
|
149 |
132 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
102 |
93 |
$13K |
| D9310 |
|
286 |
228 |
$12K |
| D0240 |
|
412 |
238 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
91 |
$8K |
| D2140 |
|
33 |
18 |
$2K |
| D7111 |
|
21 |
14 |
$1K |
| D9110 |
|
22 |
21 |
$1K |
| D1354 |
|
54 |
16 |
$780.00 |
| D0340 |
|
82 |
71 |
$0.00 |