| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
898 |
898 |
$943K |
| D1110 |
Prophylaxis - adult |
971 |
971 |
$43K |
| D9310 |
|
813 |
813 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,803 |
1,803 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,012 |
2,012 |
$30K |
| D1120 |
Prophylaxis - child |
714 |
714 |
$21K |
| D0470 |
|
559 |
559 |
$20K |
| D0330 |
Panoramic radiographic image |
364 |
364 |
$17K |
| D0350 |
|
520 |
519 |
$15K |
| D0274 |
Bitewings - four radiographic images |
490 |
490 |
$14K |
| D0340 |
|
194 |
194 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
81 |
56 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
102 |
63 |
$6K |
| D2140 |
|
37 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
72 |
16 |
$2K |
| D0272 |
Bitewings - two radiographic images |
96 |
96 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
48 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
16 |
$418.08 |