| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
930 |
929 |
$256K |
| D1110 |
Prophylaxis - adult |
1,742 |
1,728 |
$72K |
| D2740 |
Crown - porcelain/ceramic |
75 |
45 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,735 |
1,727 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,754 |
1,740 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
761 |
734 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,062 |
1,059 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
208 |
$20K |
| D1320 |
|
905 |
894 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
262 |
236 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
285 |
151 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
539 |
536 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
25 |
$15K |
| D2950 |
|
76 |
65 |
$11K |
| D1120 |
Prophylaxis - child |
409 |
407 |
$11K |
| D2931 |
|
42 |
28 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
959 |
880 |
$6K |
| D0180 |
|
203 |
203 |
$5K |
| D0470 |
|
195 |
195 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
551 |
425 |
$3K |
| D0330 |
Panoramic radiographic image |
73 |
73 |
$3K |
| D0340 |
|
45 |
45 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
13 |
$702.00 |
| D0350 |
|
47 |
47 |
$578.57 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$260.00 |