| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,648 |
1,500 |
$184K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
26 |
26 |
$20K |
| D9310 |
|
204 |
204 |
$3K |
| D0470 |
|
61 |
56 |
$2K |
| D0330 |
Panoramic radiographic image |
82 |
77 |
$2K |
| D0350 |
|
61 |
56 |
$654.96 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$129.60 |
| D0340 |
|
15 |
12 |
$30.91 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20 |
20 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
33 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
18 |
18 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
19 |
19 |
$0.00 |
| D1999 |
|
446 |
398 |
$0.00 |
| D1120 |
Prophylaxis - child |
16 |
16 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
39 |
39 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
23 |
23 |
$0.00 |
| D1110 |
Prophylaxis - adult |
23 |
23 |
$0.00 |