| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
630 |
594 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
2,238 |
2,216 |
$20K |
| D1110 |
Prophylaxis - adult |
1,969 |
1,946 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
491 |
256 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,001 |
994 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
946 |
937 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,531 |
1,516 |
$7K |
| D1120 |
Prophylaxis - child |
657 |
650 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
2,477 |
2,402 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
651 |
645 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,838 |
1,797 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
180 |
111 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
337 |
311 |
$2K |
| D2750 |
|
29 |
25 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
69 |
45 |
$1K |
| D8660 |
|
12 |
12 |
$530.00 |
| D0330 |
Panoramic radiographic image |
48 |
48 |
$488.25 |
| D2954 |
|
16 |
13 |
$270.00 |
| D0340 |
|
13 |
13 |
$195.00 |