| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
549 |
526 |
$135K |
| D1110 |
Prophylaxis - adult |
757 |
746 |
$25K |
| D7899 |
|
35 |
35 |
$16K |
| D0330 |
Panoramic radiographic image |
302 |
297 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
765 |
753 |
$12K |
| D8680 |
|
32 |
27 |
$11K |
| D0274 |
Bitewings - four radiographic images |
420 |
415 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
547 |
536 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
291 |
284 |
$7K |
| D1120 |
Prophylaxis - child |
281 |
276 |
$6K |
| D0340 |
|
93 |
88 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
186 |
184 |
$2K |
| D0470 |
|
93 |
88 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
45 |
45 |
$993.52 |
| D0350 |
|
93 |
88 |
$849.39 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$180.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$55.00 |