| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,468 |
2,384 |
$575K |
| D1110 |
Prophylaxis - adult |
3,596 |
3,592 |
$207K |
| D0120 |
Periodic oral evaluation - established patient |
6,281 |
6,275 |
$185K |
| D1120 |
Prophylaxis - child |
3,086 |
3,085 |
$140K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,454 |
5,454 |
$80K |
| D1351 |
Sealant - per tooth |
871 |
311 |
$57K |
| D0330 |
Panoramic radiographic image |
1,352 |
1,346 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
460 |
395 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,091 |
1,086 |
$31K |
| D1206 |
Topical application of fluoride varnish |
478 |
474 |
$14K |
| D0272 |
Bitewings - two radiographic images |
783 |
783 |
$13K |
| D0340 |
|
183 |
183 |
$11K |
| D8660 |
|
261 |
260 |
$7K |
| D0350 |
|
419 |
419 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
108 |
108 |
$3K |
| D0470 |
|
85 |
85 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
87 |
85 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$932.75 |
| D1999 |
|
65 |
63 |
$0.00 |