| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
371 |
314 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
226 |
106 |
$21K |
| D1120 |
Prophylaxis - child |
842 |
759 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
467 |
432 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
418 |
392 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
186 |
157 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
115 |
101 |
$4K |
| D0272 |
Bitewings - two radiographic images |
134 |
128 |
$2K |
| D0330 |
Panoramic radiographic image |
41 |
34 |
$2K |
| D0274 |
Bitewings - four radiographic images |
63 |
58 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
57 |
52 |
$539.30 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$319.00 |