| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
320 |
308 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
857 |
793 |
$57K |
| D1320 |
|
2,070 |
1,967 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,146 |
1,061 |
$33K |
| D1110 |
Prophylaxis - adult |
851 |
799 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,493 |
1,423 |
$29K |
| D0274 |
Bitewings - four radiographic images |
939 |
887 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
928 |
867 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,226 |
1,158 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,490 |
1,387 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
248 |
224 |
$5K |
| D1120 |
Prophylaxis - child |
149 |
137 |
$3K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$648.48 |