| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
532 |
483 |
$124K |
| D1110 |
Prophylaxis - adult |
1,381 |
1,294 |
$77K |
| D2740 |
Crown - porcelain/ceramic |
63 |
43 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
301 |
173 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
953 |
932 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
26 |
25 |
$20K |
| D0274 |
Bitewings - four radiographic images |
522 |
500 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,114 |
1,065 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
337 |
316 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
194 |
177 |
$14K |
| D1206 |
Topical application of fluoride varnish |
388 |
380 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
607 |
571 |
$8K |
| D2950 |
|
34 |
28 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
40 |
$5K |
| D1120 |
Prophylaxis - child |
52 |
51 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
41 |
$2K |
| D9310 |
|
15 |
14 |
$819.00 |
| D0350 |
|
41 |
39 |
$0.00 |