| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
413 |
409 |
$155K |
| D1110 |
Prophylaxis - adult |
2,820 |
2,800 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,214 |
784 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,236 |
4,224 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
4,417 |
4,393 |
$72K |
| D1120 |
Prophylaxis - child |
1,707 |
1,706 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,850 |
1,836 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
623 |
413 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
3,787 |
3,656 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,204 |
1,151 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,382 |
2,680 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
280 |
156 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
457 |
417 |
$14K |
| D9920 |
|
143 |
131 |
$9K |
| D0330 |
Panoramic radiographic image |
171 |
160 |
$7K |
| D9994 |
|
1,175 |
1,163 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
128 |
121 |
$3K |
| D1351 |
Sealant - per tooth |
41 |
12 |
$1K |
| D9992 |
|
280 |
279 |
$911.00 |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$826.15 |