| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
516 |
440 |
$97K |
| D1110 |
Prophylaxis - adult |
1,413 |
1,237 |
$67K |
| D0274 |
Bitewings - four radiographic images |
757 |
688 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
970 |
862 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
428 |
391 |
$10K |
| D1120 |
Prophylaxis - child |
132 |
124 |
$6K |
| D1206 |
Topical application of fluoride varnish |
200 |
165 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
89 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
51 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
151 |
144 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
116 |
99 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
22 |
21 |
$801.00 |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$567.00 |