| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
953 |
883 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
979 |
960 |
$27K |
| D1120 |
Prophylaxis - child |
753 |
744 |
$21K |
| D1110 |
Prophylaxis - adult |
336 |
325 |
$13K |
| D1206 |
Topical application of fluoride varnish |
714 |
712 |
$11K |
| D0330 |
Panoramic radiographic image |
229 |
228 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
468 |
451 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
173 |
172 |
$7K |
| D0272 |
Bitewings - two radiographic images |
305 |
305 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
73 |
37 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
163 |
162 |
$4K |
| D0274 |
Bitewings - four radiographic images |
122 |
121 |
$3K |
| D9310 |
|
29 |
25 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
39 |
$816.00 |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
79 |
$784.08 |
| D0230 |
Intraoral - periapical each additional radiographic image |
47 |
25 |
$740.00 |