| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,162 |
965 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
943 |
444 |
$71K |
| D1120 |
Prophylaxis - child |
2,725 |
2,264 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,187 |
1,683 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
592 |
315 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,116 |
1,735 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,398 |
1,198 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
928 |
853 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
918 |
661 |
$21K |
| D0330 |
Panoramic radiographic image |
373 |
358 |
$15K |
| D1206 |
Topical application of fluoride varnish |
584 |
566 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
62 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
48 |
15 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
149 |
135 |
$6K |
| D1110 |
Prophylaxis - adult |
85 |
82 |
$3K |
| D1351 |
Sealant - per tooth |
29 |
12 |
$869.61 |