| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,161 |
1,098 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,477 |
3,312 |
$87K |
| D1120 |
Prophylaxis - child |
2,781 |
2,634 |
$70K |
| D1206 |
Topical application of fluoride varnish |
3,341 |
3,142 |
$50K |
| D1110 |
Prophylaxis - adult |
1,074 |
1,019 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
169 |
79 |
$18K |
| D0272 |
Bitewings - two radiographic images |
748 |
709 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
250 |
246 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
64 |
54 |
$3K |
| D0274 |
Bitewings - four radiographic images |
61 |
56 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
37 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
25 |
$390.00 |