| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
7,725 |
7,383 |
$1.98M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
206 |
194 |
$244K |
| D8680 |
|
2,453 |
2,245 |
$225K |
| D9450 |
|
2,757 |
2,677 |
$69K |
| D8660 |
|
183 |
174 |
$22K |
| D1120 |
Prophylaxis - child |
265 |
236 |
$12K |
| D1206 |
Topical application of fluoride varnish |
253 |
215 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
111 |
89 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
173 |
158 |
$4K |
| D8999 |
|
29 |
26 |
$1K |
| D9941 |
|
12 |
12 |
$1K |
| D9310 |
|
20 |
18 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
18 |
13 |
$637.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
13 |
$377.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
12 |
$360.00 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$200.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
13 |
$160.00 |
| D1999 |
|
76 |
67 |
$0.00 |