| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
6,036 |
5,912 |
$609K |
| D0340 |
|
2,050 |
2,046 |
$73K |
| D1110 |
Prophylaxis - adult |
1,943 |
1,941 |
$66K |
| D0330 |
Panoramic radiographic image |
2,637 |
2,630 |
$65K |
| D8660 |
|
2,069 |
2,055 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,324 |
2,320 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,877 |
1,870 |
$37K |
| D0470 |
|
1,505 |
1,501 |
$36K |
| D0350 |
|
2,619 |
2,617 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,466 |
1,457 |
$18K |
| D1206 |
Topical application of fluoride varnish |
651 |
650 |
$15K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
12 |
12 |
$9K |
| D1120 |
Prophylaxis - child |
171 |
170 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
341 |
322 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
35 |
30 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
45 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
152 |
151 |
$2K |
| D1320 |
|
154 |
152 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
52 |
$921.17 |
| D8680 |
|
34 |
28 |
$696.00 |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
37 |
$270.30 |
| D1310 |
|
47 |
46 |
$248.79 |
| D1330 |
|
46 |
45 |
$227.28 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
30 |
$161.53 |