| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,771 |
2,357 |
$613K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,509 |
1,362 |
$600K |
| D1351 |
Sealant - per tooth |
6,996 |
1,743 |
$305K |
| D0120 |
Periodic oral evaluation - established patient |
4,554 |
4,369 |
$182K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
918 |
651 |
$176K |
| D1206 |
Topical application of fluoride varnish |
5,387 |
5,267 |
$174K |
| D1120 |
Prophylaxis - child |
3,124 |
3,061 |
$167K |
| D1110 |
Prophylaxis - adult |
2,233 |
2,186 |
$162K |
| D8090 |
|
89 |
83 |
$159K |
| D8660 |
|
471 |
414 |
$139K |
| D0274 |
Bitewings - four radiographic images |
1,500 |
1,465 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
219 |
150 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
2,883 |
2,795 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
952 |
869 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,676 |
2,578 |
$55K |
| D0330 |
Panoramic radiographic image |
495 |
478 |
$42K |
| D0272 |
Bitewings - two radiographic images |
753 |
740 |
$27K |
| D1354 |
|
367 |
149 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
30 |
$7K |
| D0602 |
|
2,263 |
2,212 |
$0.00 |
| D0603 |
|
2,977 |
2,885 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |