| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,982 |
3,861 |
$998K |
| D1120 |
Prophylaxis - child |
18,740 |
18,626 |
$964K |
| D0120 |
Periodic oral evaluation - established patient |
24,472 |
24,321 |
$715K |
| D1206 |
Topical application of fluoride varnish |
26,680 |
26,516 |
$702K |
| D1110 |
Prophylaxis - adult |
8,282 |
8,230 |
$580K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,317 |
2,621 |
$307K |
| D1351 |
Sealant - per tooth |
6,189 |
1,756 |
$252K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,467 |
1,813 |
$247K |
| D2140 |
|
2,844 |
2,308 |
$214K |
| D0272 |
Bitewings - two radiographic images |
5,466 |
5,435 |
$165K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,560 |
2,539 |
$149K |
| D9110 |
|
1,954 |
1,920 |
$143K |
| D0274 |
Bitewings - four radiographic images |
3,277 |
3,264 |
$143K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
583 |
450 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
567 |
565 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
348 |
293 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
1,579 |
1,556 |
$32K |
| D8680 |
|
286 |
277 |
$26K |
| D0330 |
Panoramic radiographic image |
255 |
255 |
$20K |
| D2330 |
|
122 |
90 |
$11K |
| D8690 |
|
64 |
58 |
$5K |
| D8660 |
|
27 |
25 |
$3K |