| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,581 |
2,429 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
4,386 |
4,307 |
$130K |
| D1120 |
Prophylaxis - child |
2,574 |
2,511 |
$111K |
| D1206 |
Topical application of fluoride varnish |
4,267 |
4,184 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
867 |
456 |
$90K |
| D1110 |
Prophylaxis - adult |
1,408 |
1,393 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
601 |
323 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
975 |
963 |
$22K |
| D0274 |
Bitewings - four radiographic images |
821 |
809 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,673 |
1,630 |
$17K |
| D1330 |
|
1,916 |
1,879 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
223 |
217 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
161 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,282 |
1,263 |
$8K |
| D9310 |
|
96 |
92 |
$4K |
| D1351 |
Sealant - per tooth |
89 |
14 |
$3K |
| D0272 |
Bitewings - two radiographic images |
133 |
132 |
$2K |