| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
13 |
13 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
723 |
588 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
714 |
476 |
$18K |
| D1110 |
Prophylaxis - adult |
500 |
374 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
344 |
259 |
$13K |
| D1206 |
Topical application of fluoride varnish |
699 |
540 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
228 |
61 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
460 |
361 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
58 |
$9K |
| D1120 |
Prophylaxis - child |
246 |
188 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
25 |
$5K |
| D0274 |
Bitewings - four radiographic images |
156 |
123 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
404 |
299 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
17 |
$3K |
| D0330 |
Panoramic radiographic image |
197 |
78 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
16 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$245.05 |