| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,327 |
3,287 |
$649K |
| D9999 |
Unspecified adjunctive procedure, by report |
337 |
310 |
$48K |
| D8660 |
|
911 |
910 |
$26K |
| D0340 |
|
632 |
632 |
$24K |
| D0330 |
Panoramic radiographic image |
860 |
860 |
$24K |
| D0470 |
|
688 |
688 |
$18K |
| D0350 |
|
1,564 |
1,562 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
137 |
136 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
110 |
110 |
$0.00 |
| D1120 |
Prophylaxis - child |
67 |
67 |
$0.00 |
| D1110 |
Prophylaxis - adult |
23 |
23 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
53 |
53 |
$0.00 |
| D1330 |
|
71 |
71 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
76 |
76 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
105 |
105 |
$0.00 |