| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,962 |
1,892 |
$406K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
15 |
15 |
$13K |
| D8999 |
|
216 |
216 |
$10K |
| D4342 |
|
53 |
22 |
$6K |
| D1120 |
Prophylaxis - child |
146 |
145 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
168 |
165 |
$5K |
| D4341 |
|
31 |
12 |
$4K |
| D1206 |
Topical application of fluoride varnish |
135 |
134 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
124 |
119 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
91 |
87 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
25 |
$2K |
| D8660 |
|
16 |
16 |
$2K |
| D1110 |
Prophylaxis - adult |
40 |
39 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
18 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
198 |
190 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
48 |
$844.98 |
| D0230 |
Intraoral - periapical each additional radiographic image |
168 |
162 |
$638.40 |
| D8680 |
|
12 |
12 |
$450.00 |
| D0330 |
Panoramic radiographic image |
17 |
16 |
$322.10 |
| D0272 |
Bitewings - two radiographic images |
22 |
22 |
$206.80 |
| D1999 |
|
110 |
100 |
$0.00 |