| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
35,820 |
30,374 |
$10.01M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
4,506 |
3,667 |
$3.59M |
| D8030 |
|
24,148 |
20,436 |
$1.73M |
| D0340 |
|
16,894 |
14,738 |
$1.15M |
| D0330 |
Panoramic radiographic image |
19,295 |
16,989 |
$968K |
| D8680 |
|
3,745 |
1,513 |
$751K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,360 |
12,280 |
$358K |
| D0350 |
|
19,589 |
17,247 |
$302K |
| D0470 |
|
5,433 |
4,629 |
$137K |
| D0140 |
Limited oral evaluation - problem focused |
136 |
128 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
41 |
41 |
$992.00 |
| D0120 |
Periodic oral evaluation - established patient |
21 |
21 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$0.00 |
| D8660 |
|
64 |
59 |
$0.00 |