| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
367 |
355 |
$50K |
| D4341 |
|
186 |
107 |
$31K |
| D1120 |
Prophylaxis - child |
544 |
533 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
556 |
542 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
495 |
487 |
$13K |
| D9310 |
|
749 |
676 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
429 |
413 |
$11K |
| D0330 |
Panoramic radiographic image |
535 |
475 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
135 |
115 |
$8K |
| D0274 |
Bitewings - four radiographic images |
392 |
375 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
152 |
116 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
222 |
213 |
$4K |
| D1110 |
Prophylaxis - adult |
78 |
75 |
$4K |
| D8999 |
|
78 |
78 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
35 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
419 |
379 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
98 |
96 |
$2K |
| D4910 |
|
27 |
27 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
292 |
240 |
$1K |
| D0272 |
Bitewings - two radiographic images |
35 |
34 |
$423.73 |