| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8660 |
|
1,636 |
1,632 |
$229K |
| D8670 |
Periodic orthodontic treatment visit |
1,138 |
1,138 |
$146K |
| D0340 |
|
1,649 |
1,643 |
$96K |
| D0330 |
Panoramic radiographic image |
1,653 |
1,649 |
$86K |
| D0350 |
|
1,630 |
1,626 |
$51K |
| D8090 |
|
13 |
13 |
$34K |
| D8680 |
|
63 |
63 |
$15K |
| D1120 |
Prophylaxis - child |
222 |
222 |
$12K |
| D1206 |
Topical application of fluoride varnish |
259 |
259 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
162 |
162 |
$8K |
| D0470 |
|
148 |
148 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
13 |
$4K |
| D0272 |
Bitewings - two radiographic images |
68 |
68 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
19 |
19 |
$728.65 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$461.44 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$434.07 |