| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
6,412 |
6,075 |
$579K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
855 |
271 |
$65K |
| D1110 |
Prophylaxis - adult |
1,577 |
1,493 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,598 |
1,505 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
802 |
758 |
$13K |
| D0274 |
Bitewings - four radiographic images |
451 |
413 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
53 |
$10K |
| D0330 |
Panoramic radiographic image |
175 |
158 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
198 |
184 |
$7K |
| D7230 |
|
35 |
12 |
$6K |
| D0340 |
|
72 |
65 |
$3K |
| D0470 |
|
68 |
62 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
51 |
50 |
$2K |
| D1120 |
Prophylaxis - child |
14 |
14 |
$320.68 |