| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
78 |
69 |
$3K |
| D8660 |
|
107 |
96 |
$970.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,456 |
1,419 |
$0.00 |
| D1120 |
Prophylaxis - child |
155 |
153 |
$0.00 |
| D1110 |
Prophylaxis - adult |
2,287 |
2,250 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
272 |
212 |
$0.00 |
| D0330 |
Panoramic radiographic image |
168 |
162 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
726 |
715 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
14 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
1,295 |
1,280 |
$0.00 |
| D2752 |
|
47 |
43 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,045 |
990 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,654 |
1,631 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,187 |
857 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,840 |
1,822 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
89 |
88 |
$0.00 |
| D1330 |
|
593 |
576 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
804 |
780 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
143 |
125 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
34 |
$0.00 |