| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
4,285 |
3,473 |
$1.09M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,262 |
1,269 |
$569K |
| D8660 |
|
1,175 |
1,121 |
$409K |
| D1351 |
Sealant - per tooth |
5,902 |
1,289 |
$252K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,109 |
703 |
$221K |
| D0274 |
Bitewings - four radiographic images |
3,968 |
3,828 |
$201K |
| D8090 |
|
93 |
88 |
$167K |
| D1110 |
Prophylaxis - adult |
2,151 |
2,092 |
$148K |
| D1206 |
Topical application of fluoride varnish |
4,587 |
4,422 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,277 |
2,122 |
$139K |
| D1120 |
Prophylaxis - child |
2,599 |
2,503 |
$135K |
| D0330 |
Panoramic radiographic image |
1,456 |
1,390 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
2,782 |
2,688 |
$113K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
227 |
161 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
13 |
$4K |
| D1354 |
|
60 |
14 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
43 |
39 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$402.60 |
| D0603 |
|
13,867 |
10,804 |
$0.00 |
| D0602 |
|
15 |
15 |
$0.00 |