| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
552 |
552 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
1,499 |
1,499 |
$70K |
| D1120 |
Prophylaxis - child |
1,491 |
1,489 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,386 |
2,065 |
$41K |
| D1110 |
Prophylaxis - adult |
505 |
505 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
655 |
654 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,382 |
1,382 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,160 |
2,158 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
349 |
228 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
263 |
263 |
$12K |
| D1351 |
Sealant - per tooth |
212 |
83 |
$5K |
| D9430 |
|
130 |
130 |
$4K |
| D2140 |
|
38 |
27 |
$2K |
| D2160 |
|
13 |
12 |
$1K |
| D0350 |
|
106 |
68 |
$872.40 |
| D0220 |
Intraoral - periapical first radiographic image |
47 |
47 |
$564.00 |
| D0272 |
Bitewings - two radiographic images |
42 |
42 |
$469.00 |