| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
8,122 |
7,705 |
$2.03M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
737 |
715 |
$450K |
| D8030 |
|
3,891 |
3,755 |
$304K |
| D0340 |
|
2,928 |
2,843 |
$181K |
| D8680 |
|
626 |
380 |
$140K |
| D0330 |
Panoramic radiographic image |
3,022 |
2,934 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,995 |
2,901 |
$81K |
| D0470 |
|
2,656 |
2,062 |
$48K |
| D0350 |
|
2,905 |
2,825 |
$37K |
| D1110 |
Prophylaxis - adult |
679 |
643 |
$33K |
| D0274 |
Bitewings - four radiographic images |
706 |
670 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
746 |
713 |
$19K |
| D1206 |
Topical application of fluoride varnish |
704 |
674 |
$15K |
| D1351 |
Sealant - per tooth |
559 |
131 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
67 |
$2K |
| D1120 |
Prophylaxis - child |
53 |
53 |
$1K |
| D0272 |
Bitewings - two radiographic images |
36 |
36 |
$350.00 |