| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,461 |
2,154 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
452 |
431 |
$27K |
| D1330 |
|
1,206 |
1,148 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
218 |
140 |
$12K |
| D0330 |
Panoramic radiographic image |
169 |
158 |
$10K |
| D1351 |
Sealant - per tooth |
739 |
235 |
$7K |
| D8660 |
|
295 |
212 |
$4K |
| D1120 |
Prophylaxis - child |
1,049 |
998 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
27 |
$2K |
| D1110 |
Prophylaxis - adult |
73 |
67 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
14 |
$811.29 |
| D0230 |
Intraoral - periapical each additional radiographic image |
161 |
156 |
$307.38 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
147 |
136 |
$182.82 |
| D1206 |
Topical application of fluoride varnish |
425 |
409 |
$42.70 |
| D0272 |
Bitewings - two radiographic images |
421 |
403 |
$26.76 |
| D0274 |
Bitewings - four radiographic images |
139 |
126 |
$16.35 |
| D0603 |
|
194 |
182 |
$0.00 |
| D0601 |
|
681 |
656 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
641 |
608 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
654 |
623 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
219 |
210 |
$0.00 |