| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,379 |
2,320 |
$176K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,273 |
641 |
$172K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
929 |
525 |
$161K |
| D1110 |
Prophylaxis - adult |
1,669 |
1,640 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,334 |
1,307 |
$73K |
| D1206 |
Topical application of fluoride varnish |
2,558 |
2,515 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
482 |
277 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,493 |
1,473 |
$45K |
| D2740 |
Crown - porcelain/ceramic |
103 |
63 |
$41K |
| D1120 |
Prophylaxis - child |
741 |
728 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,204 |
1,177 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
473 |
473 |
$27K |
| D2335 |
|
139 |
68 |
$24K |
| D2950 |
|
200 |
118 |
$17K |
| D2750 |
|
19 |
15 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
187 |
185 |
$9K |
| D2330 |
|
83 |
53 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
571 |
566 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
300 |
300 |
$4K |
| D2332 |
|
24 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
67 |
67 |
$3K |
| D4341 |
|
36 |
16 |
$3K |
| D1330 |
|
198 |
198 |
$1K |
| D0272 |
Bitewings - two radiographic images |
26 |
25 |
$375.00 |