| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,676 |
1,268 |
$184K |
| D1120 |
Prophylaxis - child |
3,712 |
3,245 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
754 |
427 |
$70K |
| D1206 |
Topical application of fluoride varnish |
3,410 |
2,969 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,873 |
1,767 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,481 |
1,149 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,177 |
1,051 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,861 |
1,551 |
$38K |
| D0330 |
Panoramic radiographic image |
1,028 |
939 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
303 |
165 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,172 |
978 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
66 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
24 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
57 |
$4K |
| D0272 |
Bitewings - two radiographic images |
28 |
27 |
$478.24 |
| D1999 |
|
42 |
29 |
$0.00 |