| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
7,069 |
6,786 |
$462K |
| D8660 |
|
398 |
397 |
$49K |
| D8680 |
|
14 |
14 |
$13K |
| D9310 |
|
409 |
405 |
$8K |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
43 |
39 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
19 |
19 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
55 |
55 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
24 |
24 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
20 |
20 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
39 |
39 |
$0.00 |
| D1120 |
Prophylaxis - child |
48 |
48 |
$0.00 |