| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,014 |
970 |
$238K |
| D1110 |
Prophylaxis - adult |
3,465 |
3,356 |
$204K |
| D0120 |
Periodic oral evaluation - established patient |
7,108 |
6,901 |
$186K |
| D1120 |
Prophylaxis - child |
3,430 |
3,330 |
$167K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,665 |
5,507 |
$156K |
| D0274 |
Bitewings - four radiographic images |
1,928 |
1,866 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
657 |
362 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
750 |
421 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
2,413 |
2,353 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,040 |
1,917 |
$28K |
| D0272 |
Bitewings - two radiographic images |
989 |
974 |
$28K |
| D1351 |
Sealant - per tooth |
737 |
236 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
109 |
61 |
$9K |
| D1206 |
Topical application of fluoride varnish |
122 |
118 |
$3K |
| D9110 |
|
31 |
29 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
25 |
$1K |
| D8680 |
|
14 |
13 |
$1K |
| D1999 |
|
721 |
669 |
$0.00 |