| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,166 |
4,166 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
7,206 |
7,200 |
$59K |
| D8670 |
Periodic orthodontic treatment visit |
205 |
205 |
$47K |
| D0274 |
Bitewings - four radiographic images |
3,713 |
3,710 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
7,915 |
7,884 |
$26K |
| D1120 |
Prophylaxis - child |
1,769 |
1,767 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,172 |
6,159 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,159 |
2,158 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
1,801 |
1,795 |
$8K |
| D0272 |
Bitewings - two radiographic images |
1,692 |
1,690 |
$7K |
| D0340 |
|
38 |
38 |
$2K |
| D8660 |
|
54 |
54 |
$2K |
| D0330 |
Panoramic radiographic image |
40 |
40 |
$1K |
| D1999 |
|
18 |
18 |
$900.00 |
| D1351 |
Sealant - per tooth |
13 |
13 |
$579.41 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$263.25 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$202.73 |
| D0602 |
|
42 |
42 |
$42.00 |