| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
6,383 |
6,230 |
$1.50M |
| D0330 |
Panoramic radiographic image |
3,516 |
3,444 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,073 |
3,002 |
$68K |
| D1120 |
Prophylaxis - child |
1,601 |
1,561 |
$63K |
| D8999 |
|
1,282 |
1,238 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,136 |
2,075 |
$57K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
44 |
42 |
$38K |
| D8680 |
|
233 |
230 |
$33K |
| D1206 |
Topical application of fluoride varnish |
846 |
826 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
696 |
682 |
$18K |
| D8660 |
|
195 |
193 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
100 |
70 |
$7K |
| D1351 |
Sealant - per tooth |
32 |
16 |
$2K |