| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
582 |
216 |
$64K |
| D1110 |
Prophylaxis - adult |
1,382 |
1,102 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,654 |
1,348 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,628 |
1,293 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,498 |
1,186 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
223 |
89 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
698 |
510 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
367 |
318 |
$11K |
| D1120 |
Prophylaxis - child |
247 |
180 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
341 |
249 |
$5K |
| D1351 |
Sealant - per tooth |
83 |
27 |
$2K |
| D0602 |
|
426 |
369 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
77 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$689.70 |
| D0601 |
|
69 |
40 |
$245.00 |
| D0603 |
|
48 |
38 |
$225.00 |