| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
245 |
233 |
$27K |
| D1120 |
Prophylaxis - child |
458 |
332 |
$10K |
| D1206 |
Topical application of fluoride varnish |
201 |
126 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
174 |
148 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
15 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
102 |
77 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
123 |
97 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
14 |
$988.02 |
| D0330 |
Panoramic radiographic image |
48 |
31 |
$916.00 |
| D0274 |
Bitewings - four radiographic images |
67 |
53 |
$837.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
119 |
85 |
$703.38 |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
16 |
$75.24 |