| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,944 |
3,813 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
3,687 |
3,590 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,245 |
3,192 |
$74K |
| D1120 |
Prophylaxis - child |
1,724 |
1,699 |
$71K |
| D1110 |
Prophylaxis - adult |
2,125 |
2,043 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,184 |
2,118 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,957 |
1,884 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
317 |
192 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
922 |
847 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
216 |
181 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
108 |
108 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
40 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
15 |
$1K |
| D2140 |
|
14 |
12 |
$642.20 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$439.04 |