| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8030 |
|
2,124 |
1,944 |
$181K |
| D8670 |
Periodic orthodontic treatment visit |
279 |
191 |
$45K |
| D1110 |
Prophylaxis - adult |
930 |
870 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,045 |
994 |
$17K |
| D0274 |
Bitewings - four radiographic images |
735 |
705 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
369 |
347 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
620 |
588 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
181 |
162 |
$9K |
| D0330 |
Panoramic radiographic image |
132 |
123 |
$5K |
| D0340 |
|
86 |
78 |
$5K |
| D1120 |
Prophylaxis - child |
151 |
144 |
$3K |
| D0470 |
|
134 |
124 |
$3K |
| D0350 |
|
98 |
91 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D1320 |
|
24 |
24 |
$375.00 |
| D0220 |
Intraoral - periapical first radiographic image |
50 |
44 |
$214.50 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$126.00 |