| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
336 |
334 |
$98K |
| D1120 |
Prophylaxis - child |
3,026 |
2,992 |
$82K |
| D1206 |
Topical application of fluoride varnish |
4,182 |
4,129 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
3,566 |
3,528 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,294 |
1,184 |
$50K |
| D1110 |
Prophylaxis - adult |
949 |
941 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,589 |
1,572 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
404 |
249 |
$23K |
| D1351 |
Sealant - per tooth |
684 |
118 |
$19K |
| D1330 |
|
2,733 |
2,707 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
445 |
445 |
$10K |
| D1310 |
|
1,591 |
1,566 |
$10K |
| D0330 |
Panoramic radiographic image |
213 |
213 |
$9K |
| D0603 |
|
803 |
799 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
78 |
$6K |
| D0601 |
|
717 |
706 |
$6K |
| D2140 |
|
101 |
80 |
$5K |
| D0274 |
Bitewings - four radiographic images |
125 |
125 |
$4K |
| D0602 |
|
303 |
303 |
$3K |
| D8660 |
|
13 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
275 |
275 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
131 |
118 |
$1K |
| D1999 |
|
192 |
182 |
$0.31 |