| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
234 |
233 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
646 |
646 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
523 |
521 |
$33K |
| D0340 |
|
563 |
562 |
$28K |
| D9430 |
|
714 |
597 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
441 |
441 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
580 |
580 |
$20K |
| D1120 |
Prophylaxis - child |
508 |
507 |
$19K |
| D0330 |
Panoramic radiographic image |
614 |
614 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,379 |
666 |
$14K |
| D0350 |
|
1,065 |
317 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
732 |
728 |
$9K |
| D0274 |
Bitewings - four radiographic images |
422 |
420 |
$9K |
| D1110 |
Prophylaxis - adult |
91 |
91 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
42 |
42 |
$691.50 |