| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
496 |
488 |
$408K |
| D8670 |
Periodic orthodontic treatment visit |
2,248 |
2,226 |
$221K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,156 |
1,102 |
$49K |
| D0330 |
Panoramic radiographic image |
742 |
704 |
$42K |
| D0340 |
|
742 |
705 |
$37K |
| D0470 |
|
742 |
705 |
$30K |
| D9110 |
|
262 |
259 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
477 |
443 |
$11K |
| D1206 |
Topical application of fluoride varnish |
691 |
629 |
$10K |
| D1110 |
Prophylaxis - adult |
269 |
259 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
64 |
$9K |
| D1120 |
Prophylaxis - child |
275 |
264 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
455 |
399 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
462 |
339 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
83 |
79 |
$1K |
| D0274 |
Bitewings - four radiographic images |
47 |
43 |
$1K |