| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,310 |
748 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
829 |
803 |
$9K |
| D1110 |
Prophylaxis - adult |
320 |
313 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
426 |
409 |
$5K |
| D8660 |
|
76 |
71 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
40 |
$749.52 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
146 |
128 |
$407.57 |
| D0272 |
Bitewings - two radiographic images |
493 |
482 |
$165.72 |
| D1120 |
Prophylaxis - child |
978 |
942 |
$71.66 |
| D1206 |
Topical application of fluoride varnish |
1,022 |
984 |
$16.42 |
| D0220 |
Intraoral - periapical first radiographic image |
242 |
234 |
$9.48 |
| D1351 |
Sealant - per tooth |
310 |
80 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
103 |
99 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
116 |
114 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
30 |
$0.00 |
| D1330 |
|
546 |
524 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
39 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
86 |
85 |
$0.00 |
| D0330 |
Panoramic radiographic image |
33 |
33 |
$0.00 |
| D1354 |
|
41 |
12 |
$0.00 |