| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
2,340 |
2,335 |
$518K |
| D0340 |
|
892 |
891 |
$44K |
| D0330 |
Panoramic radiographic image |
882 |
881 |
$27K |
| D8660 |
|
892 |
892 |
$25K |
| D0470 |
|
699 |
698 |
$22K |
| D0350 |
|
1,330 |
1,328 |
$15K |
| D8680 |
|
25 |
25 |
$4K |
| D1120 |
Prophylaxis - child |
134 |
134 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
137 |
137 |
$3K |
| D9310 |
|
73 |
72 |
$2K |
| D0274 |
Bitewings - four radiographic images |
99 |
99 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
179 |
179 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
128 |
128 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
140 |
140 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
123 |
123 |
$622.30 |
| D1999 |
|
147 |
147 |
$0.00 |