| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,945 |
1,785 |
$443K |
| D1120 |
Prophylaxis - child |
6,194 |
6,105 |
$273K |
| D0120 |
Periodic oral evaluation - established patient |
7,844 |
7,700 |
$189K |
| D1206 |
Topical application of fluoride varnish |
8,065 |
7,915 |
$180K |
| D1110 |
Prophylaxis - adult |
879 |
859 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,431 |
1,405 |
$37K |
| D8680 |
|
133 |
116 |
$12K |
| D0274 |
Bitewings - four radiographic images |
351 |
344 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
146 |
145 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
319 |
292 |
$5K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$2K |
| D1351 |
Sealant - per tooth |
39 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
44 |
38 |
$840.00 |