| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,954 |
2,868 |
$248K |
| D1110 |
Prophylaxis - adult |
4,560 |
4,094 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
5,449 |
4,966 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
3,101 |
2,867 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,286 |
2,154 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,041 |
612 |
$58K |
| D0330 |
Panoramic radiographic image |
809 |
754 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
623 |
333 |
$31K |
| D1120 |
Prophylaxis - child |
742 |
697 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,250 |
910 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
708 |
523 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,193 |
1,008 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,281 |
2,078 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
186 |
81 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
361 |
314 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
640 |
315 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
12 |
$1K |