| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,211 |
1,169 |
$261K |
| D1110 |
Prophylaxis - adult |
2,668 |
2,576 |
$140K |
| D0274 |
Bitewings - four radiographic images |
1,835 |
1,770 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,718 |
2,632 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
419 |
267 |
$34K |
| D1120 |
Prophylaxis - child |
714 |
698 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
985 |
962 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
137 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
184 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
43 |
27 |
$3K |
| D8660 |
|
86 |
84 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
14 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
40 |
$629.00 |
| D9110 |
|
14 |
14 |
$546.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$360.00 |
| D1999 |
|
20 |
19 |
$0.00 |