| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8660 |
|
1,002 |
984 |
$139K |
| D8670 |
Periodic orthodontic treatment visit |
575 |
564 |
$73K |
| D8090 |
|
26 |
26 |
$69K |
| D0340 |
|
1,036 |
1,018 |
$60K |
| D0330 |
Panoramic radiographic image |
918 |
900 |
$47K |
| D0350 |
|
1,020 |
1,001 |
$32K |
| D1110 |
Prophylaxis - adult |
208 |
208 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
26 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
97 |
97 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
92 |
92 |
$3K |
| D1206 |
Topical application of fluoride varnish |
55 |
55 |
$1K |
| D0274 |
Bitewings - four radiographic images |
19 |
19 |
$598.64 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$114.30 |