| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
211 |
211 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
800 |
797 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
574 |
573 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,515 |
865 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
283 |
277 |
$12K |
| D1120 |
Prophylaxis - child |
327 |
319 |
$10K |
| D9430 |
|
264 |
236 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
517 |
507 |
$5K |
| D0272 |
Bitewings - two radiographic images |
470 |
455 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
235 |
220 |
$3K |
| D1110 |
Prophylaxis - adult |
32 |
32 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
18 |
17 |
$510.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$259.20 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$174.00 |