| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
8,137 |
7,907 |
$600K |
| D8660 |
|
3,018 |
2,966 |
$219K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
708 |
686 |
$54K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
76 |
42 |
$40K |
| D0340 |
|
525 |
503 |
$20K |
| D9310 |
|
641 |
640 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
326 |
326 |
$16K |
| D1120 |
Prophylaxis - child |
351 |
351 |
$5K |
| D9248 |
|
13 |
13 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$2K |
| D0350 |
|
519 |
497 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
47 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
88 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
42 |
42 |
$840.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
29 |
29 |
$791.00 |
| D0272 |
Bitewings - two radiographic images |
210 |
210 |
$643.64 |
| D0220 |
Intraoral - periapical first radiographic image |
304 |
298 |
$476.53 |
| D1330 |
|
489 |
489 |
$466.69 |
| D0470 |
|
501 |
479 |
$159.03 |
| D0330 |
Panoramic radiographic image |
525 |
503 |
$112.96 |
| D1208 |
Topical application of fluoride, excluding varnish |
353 |
353 |
$90.55 |
| D9986 |
|
16 |
16 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
107 |
106 |
$0.00 |