| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,363 |
1,116 |
$130K |
| D1120 |
Prophylaxis - child |
2,883 |
2,522 |
$70K |
| D1351 |
Sealant - per tooth |
2,523 |
378 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
1,169 |
1,107 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,465 |
1,205 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,072 |
947 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
106 |
$20K |
| D0330 |
Panoramic radiographic image |
313 |
294 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
557 |
382 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
598 |
556 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
259 |
233 |
$9K |
| D9310 |
|
48 |
48 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
164 |
141 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
16 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
14 |
$305.54 |