| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,647 |
1,616 |
$498K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
566 |
305 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
379 |
216 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
863 |
862 |
$20K |
| D1110 |
Prophylaxis - adult |
464 |
464 |
$19K |
| D1120 |
Prophylaxis - child |
514 |
513 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
642 |
641 |
$14K |
| D1351 |
Sealant - per tooth |
273 |
42 |
$8K |
| D0274 |
Bitewings - four radiographic images |
245 |
245 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
99 |
90 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
150 |
150 |
$3K |
| D0272 |
Bitewings - two radiographic images |
96 |
96 |
$2K |
| D8660 |
|
13 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
166 |
162 |
$1K |
| D9110 |
|
40 |
40 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
14 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$444.00 |