| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
660 |
522 |
$70K |
| D1110 |
Prophylaxis - adult |
1,403 |
1,378 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,663 |
1,631 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,454 |
1,431 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,437 |
1,411 |
$27K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
43 |
41 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
682 |
623 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
131 |
64 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
77 |
42 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
206 |
203 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
39 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
82 |
$3K |
| D2140 |
|
15 |
13 |
$983.25 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$433.20 |
| D0602 |
|
84 |
82 |
$355.00 |