| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,762 |
3,694 |
$972K |
| D1120 |
Prophylaxis - child |
14,065 |
13,928 |
$720K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,539 |
18,370 |
$545K |
| D0120 |
Periodic oral evaluation - established patient |
17,262 |
17,116 |
$507K |
| D1351 |
Sealant - per tooth |
9,488 |
2,200 |
$391K |
| D1110 |
Prophylaxis - adult |
4,332 |
4,300 |
$303K |
| D0274 |
Bitewings - four radiographic images |
4,433 |
4,400 |
$194K |
| D0272 |
Bitewings - two radiographic images |
6,269 |
6,218 |
$190K |
| D0210 |
Intraoral - complete series of radiographic images |
1,497 |
1,487 |
$134K |
| D8680 |
|
1,233 |
1,126 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
3,235 |
3,204 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
837 |
828 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,656 |
2,621 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
683 |
673 |
$32K |
| D1206 |
Topical application of fluoride varnish |
736 |
735 |
$20K |
| D9110 |
|
204 |
198 |
$15K |
| D8660 |
|
79 |
79 |
$8K |
| D9310 |
|
119 |
119 |
$7K |
| D0330 |
Panoramic radiographic image |
75 |
75 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13 |
12 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
13 |
$2K |
| D1999 |
|
21 |
21 |
$0.00 |