| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
849 |
839 |
$336K |
| D1110 |
Prophylaxis - adult |
1,109 |
1,098 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,224 |
2,206 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,791 |
1,775 |
$31K |
| D8660 |
|
125 |
125 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
430 |
249 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
347 |
179 |
$21K |
| D1120 |
Prophylaxis - child |
616 |
615 |
$19K |
| D9920 |
|
200 |
182 |
$11K |
| D0274 |
Bitewings - four radiographic images |
319 |
319 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
446 |
443 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
398 |
373 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
78 |
$2K |
| D9994 |
|
558 |
542 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
73 |
67 |
$1K |
| D0272 |
Bitewings - two radiographic images |
50 |
50 |
$705.25 |
| D0140 |
Limited oral evaluation - problem focused |
41 |
41 |
$484.20 |
| D1351 |
Sealant - per tooth |
38 |
12 |
$0.00 |