| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,234 |
13,786 |
$700K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,647 |
17,099 |
$497K |
| D0120 |
Periodic oral evaluation - established patient |
12,672 |
12,246 |
$350K |
| D1110 |
Prophylaxis - adult |
4,153 |
3,996 |
$267K |
| D1351 |
Sealant - per tooth |
6,241 |
1,399 |
$238K |
| D0272 |
Bitewings - two radiographic images |
7,777 |
7,536 |
$223K |
| D8670 |
Periodic orthodontic treatment visit |
1,264 |
1,115 |
$211K |
| D0330 |
Panoramic radiographic image |
2,490 |
2,404 |
$173K |
| D0274 |
Bitewings - four radiographic images |
3,850 |
3,739 |
$156K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
976 |
833 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,332 |
1,292 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
543 |
464 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,265 |
1,170 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
2,910 |
2,631 |
$51K |
| D8680 |
|
525 |
414 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,438 |
1,337 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
267 |
209 |
$21K |
| D0240 |
|
810 |
467 |
$15K |
| D8660 |
|
330 |
309 |
$8K |
| D2140 |
|
102 |
84 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
494 |
350 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
27 |
$4K |
| D9110 |
|
19 |
17 |
$1K |
| D1354 |
|
21 |
12 |
$315.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$286.00 |
| D1999 |
|
4,273 |
3,904 |
$0.00 |