| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
93 |
67 |
$191K |
| D0330 |
Panoramic radiographic image |
686 |
658 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
685 |
674 |
$17K |
| D0340 |
|
357 |
344 |
$15K |
| D0470 |
|
317 |
314 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
441 |
425 |
$8K |
| D1110 |
Prophylaxis - adult |
223 |
212 |
$8K |
| D1120 |
Prophylaxis - child |
183 |
178 |
$5K |
| D1206 |
Topical application of fluoride varnish |
211 |
201 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
149 |
141 |
$2K |
| D0274 |
Bitewings - four radiographic images |
54 |
51 |
$1K |
| D0272 |
Bitewings - two radiographic images |
41 |
40 |
$675.48 |
| D0140 |
Limited oral evaluation - problem focused |
72 |
42 |
$189.20 |