| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,021 |
976 |
$210K |
| D1120 |
Prophylaxis - child |
2,166 |
2,041 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
1,685 |
1,570 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,752 |
1,644 |
$43K |
| D0274 |
Bitewings - four radiographic images |
403 |
389 |
$6K |
| D1351 |
Sealant - per tooth |
65 |
34 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
200 |
193 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
57 |
48 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
300 |
288 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
25 |
$2K |
| D8999 |
|
30 |
30 |
$1K |
| D8660 |
|
27 |
27 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
82 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
208 |
201 |
$846.06 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$312.00 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$304.80 |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$272.60 |