| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,636 |
1,210 |
$144K |
| D1120 |
Prophylaxis - child |
4,353 |
3,626 |
$108K |
| D1206 |
Topical application of fluoride varnish |
4,247 |
3,531 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,383 |
1,829 |
$71K |
| D0330 |
Panoramic radiographic image |
1,759 |
1,409 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,672 |
2,188 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,960 |
1,750 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
2,030 |
1,235 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
314 |
150 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
259 |
158 |
$26K |
| D2160 |
|
466 |
74 |
$15K |
| D1351 |
Sealant - per tooth |
808 |
66 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,523 |
1,060 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
147 |
36 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
421 |
319 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
173 |
56 |
$4K |