| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,785 |
3,710 |
$1.38M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
443 |
438 |
$458K |
| D8660 |
|
1,359 |
1,351 |
$245K |
| D8680 |
|
391 |
375 |
$132K |
| D1120 |
Prophylaxis - child |
2,765 |
2,741 |
$78K |
| D1206 |
Topical application of fluoride varnish |
3,395 |
3,364 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,928 |
2,900 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,023 |
1,015 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
781 |
723 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
367 |
223 |
$20K |
| D1110 |
Prophylaxis - adult |
256 |
252 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
121 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
27 |
$3K |
| D1351 |
Sealant - per tooth |
45 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$145.34 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$0.00 |