| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
467 |
467 |
$141K |
| D1120 |
Prophylaxis - child |
1,853 |
1,839 |
$33K |
| D1206 |
Topical application of fluoride varnish |
2,549 |
2,524 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,638 |
1,623 |
$16K |
| D8660 |
|
151 |
147 |
$16K |
| D1351 |
Sealant - per tooth |
749 |
221 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
776 |
768 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
753 |
655 |
$14K |
| D1110 |
Prophylaxis - adult |
540 |
529 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
226 |
128 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,141 |
1,121 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
199 |
117 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,048 |
968 |
$6K |
| D0274 |
Bitewings - four radiographic images |
330 |
325 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
336 |
159 |
$6K |
| D0272 |
Bitewings - two radiographic images |
569 |
565 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
347 |
338 |
$4K |
| D0240 |
|
50 |
28 |
$781.55 |
| D0330 |
Panoramic radiographic image |
114 |
114 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
77 |
31 |
$0.00 |