| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,853 |
1,699 |
$382K |
| D1120 |
Prophylaxis - child |
2,264 |
2,194 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,944 |
1,887 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,667 |
1,610 |
$44K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
13 |
13 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
385 |
365 |
$8K |
| D0274 |
Bitewings - four radiographic images |
437 |
428 |
$7K |
| D1351 |
Sealant - per tooth |
88 |
36 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
41 |
$3K |
| D0272 |
Bitewings - two radiographic images |
232 |
221 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
30 |
$1K |
| D8660 |
|
35 |
30 |
$700.00 |
| D8999 |
|
13 |
12 |
$611.65 |
| D7140 |
Extraction, erupted tooth or exposed root |
12 |
12 |
$469.44 |
| D0140 |
Limited oral evaluation - problem focused |
29 |
29 |
$453.60 |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
18 |
$417.70 |
| D0220 |
Intraoral - periapical first radiographic image |
76 |
71 |
$364.00 |