| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,668 |
2,646 |
$969K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,842 |
8,750 |
$158K |
| D1120 |
Prophylaxis - child |
5,230 |
5,177 |
$155K |
| D1110 |
Prophylaxis - adult |
3,231 |
3,190 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
7,426 |
7,347 |
$129K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
109 |
109 |
$114K |
| D8660 |
|
618 |
618 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,229 |
590 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,378 |
655 |
$77K |
| D1351 |
Sealant - per tooth |
2,132 |
598 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,918 |
2,881 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,562 |
4,502 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,363 |
4,181 |
$43K |
| D8680 |
|
66 |
66 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
657 |
655 |
$20K |
| D9920 |
|
301 |
294 |
$11K |
| D0274 |
Bitewings - four radiographic images |
496 |
494 |
$9K |
| D9994 |
|
2,224 |
2,184 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
62 |
$7K |
| D8692 |
|
23 |
12 |
$3K |
| D9310 |
|
16 |
16 |
$1K |
| D9110 |
|
12 |
12 |
$581.16 |