| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
5,291 |
5,286 |
$1.49M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
529 |
529 |
$526K |
| D0140 |
Limited oral evaluation - problem focused |
3,238 |
3,232 |
$113K |
| D0470 |
|
573 |
573 |
$43K |
| D8680 |
|
124 |
62 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
536 |
536 |
$25K |
| D1120 |
Prophylaxis - child |
558 |
554 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
397 |
397 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
172 |
89 |
$10K |
| D8692 |
|
44 |
22 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
520 |
520 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
976 |
510 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
44 |
$3K |
| D0274 |
Bitewings - four radiographic images |
140 |
140 |
$3K |
| D0272 |
Bitewings - two radiographic images |
140 |
140 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
13 |
$1K |