| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,664 |
1,280 |
$125K |
| D1120 |
Prophylaxis - child |
5,345 |
4,388 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,140 |
3,205 |
$110K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,639 |
4,583 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,450 |
1,026 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,433 |
1,199 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
604 |
163 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,212 |
1,117 |
$29K |
| D0330 |
Panoramic radiographic image |
606 |
538 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
807 |
601 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
192 |
84 |
$17K |
| D0272 |
Bitewings - two radiographic images |
958 |
789 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
148 |
79 |
$12K |
| D1351 |
Sealant - per tooth |
40 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
45 |
43 |
$530.62 |