| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,912 |
6,580 |
$254K |
| D1120 |
Prophylaxis - child |
5,506 |
5,221 |
$224K |
| D1310 |
|
3,718 |
3,596 |
$151K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,689 |
5,386 |
$94K |
| D1110 |
Prophylaxis - adult |
1,840 |
1,709 |
$93K |
| D0330 |
Panoramic radiographic image |
1,566 |
1,503 |
$93K |
| D0272 |
Bitewings - two radiographic images |
3,524 |
3,368 |
$89K |
| D1351 |
Sealant - per tooth |
1,471 |
357 |
$44K |
| D1330 |
|
4,048 |
3,847 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
227 |
93 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
366 |
355 |
$14K |
| D0425 |
|
130 |
127 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
132 |
129 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
51 |
36 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
13 |
$1K |
| D0601 |
|
94 |
94 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$407.50 |
| D0602 |
|
30 |
28 |
$316.30 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$275.88 |