| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
13,214 |
12,819 |
$3.95M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
2,332 |
2,267 |
$1.65M |
| D0340 |
|
12,633 |
12,309 |
$810K |
| D8680 |
|
3,048 |
1,421 |
$684K |
| D8030 |
|
4,549 |
4,302 |
$363K |
| D0330 |
Panoramic radiographic image |
8,792 |
8,480 |
$336K |
| D0350 |
|
17,524 |
10,493 |
$183K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,064 |
5,922 |
$173K |
| D0470 |
|
5,709 |
5,605 |
$147K |
| D1516 |
|
559 |
545 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
742 |
694 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
164 |
70 |
$8K |
| D8220 |
|
35 |
30 |
$8K |
| D1517 |
|
38 |
38 |
$6K |
| D1110 |
Prophylaxis - adult |
143 |
136 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
24 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
149 |
141 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
143 |
135 |
$2K |
| D1526 |
|
12 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
72 |
69 |
$1K |
| D0274 |
Bitewings - four radiographic images |
110 |
104 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
110 |
97 |
$282.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
122 |
60 |
$225.00 |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$218.88 |
| D0272 |
Bitewings - two radiographic images |
29 |
28 |
$210.00 |
| D8660 |
|
112 |
106 |
$0.00 |
| D0351 |
|
55 |
53 |
$0.00 |