| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,763 |
5,522 |
$233K |
| D8670 |
Periodic orthodontic treatment visit |
1,008 |
963 |
$226K |
| D1351 |
Sealant - per tooth |
2,692 |
1,593 |
$204K |
| D0120 |
Periodic oral evaluation - established patient |
6,289 |
6,006 |
$171K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,761 |
5,518 |
$148K |
| D0274 |
Bitewings - four radiographic images |
6,161 |
5,869 |
$100K |
| D1110 |
Prophylaxis - adult |
1,782 |
1,693 |
$72K |
| D4342 |
|
371 |
249 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,402 |
2,290 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
9,059 |
8,578 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
739 |
638 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,662 |
8,018 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
544 |
481 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
339 |
261 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
979 |
919 |
$16K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
50 |
49 |
$15K |
| D9310 |
|
789 |
767 |
$13K |
| D8999 |
|
282 |
281 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,147 |
1,120 |
$11K |
| D1354 |
|
257 |
189 |
$9K |
| D4341 |
|
35 |
26 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
103 |
68 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
138 |
125 |
$6K |
| D2950 |
|
54 |
50 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
216 |
213 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$1K |
| D0270 |
|
92 |
91 |
$515.20 |
| D2940 |
|
18 |
12 |
$203.40 |