| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,248 |
1,246 |
$360K |
| D0120 |
Periodic oral evaluation - established patient |
2,620 |
2,608 |
$159K |
| D1120 |
Prophylaxis - child |
3,418 |
3,405 |
$134K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,910 |
4,510 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,192 |
1,189 |
$78K |
| D9430 |
|
1,994 |
1,918 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,420 |
3,404 |
$38K |
| D0330 |
Panoramic radiographic image |
1,208 |
1,206 |
$35K |
| D0272 |
Bitewings - two radiographic images |
2,244 |
2,189 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,095 |
1,091 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
645 |
645 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
324 |
161 |
$22K |
| D0350 |
|
1,489 |
479 |
$13K |
| D1351 |
Sealant - per tooth |
219 |
62 |
$7K |
| D9993 |
|
54 |
54 |
$4K |
| D0340 |
|
67 |
67 |
$3K |
| D1310 |
|
54 |
54 |
$2K |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
124 |
123 |
$1K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$206.00 |