| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
360 |
358 |
$94K |
| D1120 |
Prophylaxis - child |
1,186 |
1,165 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
980 |
973 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,061 |
1,204 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,064 |
1,045 |
$12K |
| D0330 |
Panoramic radiographic image |
376 |
374 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
301 |
301 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,018 |
1,001 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
87 |
40 |
$5K |
| D1351 |
Sealant - per tooth |
249 |
74 |
$5K |
| D9430 |
|
82 |
82 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
38 |
38 |
$1K |
| D1206 |
Topical application of fluoride varnish |
13 |
12 |
$198.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$110.00 |