| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
15,019 |
14,327 |
$1.39M |
| D8680 |
|
1,406 |
1,221 |
$1.07M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
581 |
565 |
$442K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
464 |
288 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,013 |
970 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
327 |
202 |
$38K |
| D0340 |
|
819 |
748 |
$37K |
| D0470 |
|
822 |
749 |
$30K |
| D1110 |
Prophylaxis - adult |
553 |
547 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
751 |
742 |
$17K |
| D0274 |
Bitewings - four radiographic images |
446 |
440 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
310 |
294 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
693 |
666 |
$9K |
| D4355 |
|
151 |
145 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
785 |
563 |
$9K |
| D0330 |
Panoramic radiographic image |
155 |
148 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
66 |
$7K |
| D1206 |
Topical application of fluoride varnish |
357 |
356 |
$5K |
| D2394 |
|
19 |
13 |
$3K |
| D1120 |
Prophylaxis - child |
109 |
108 |
$3K |
| D4342 |
|
22 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
53 |
51 |
$785.40 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$208.08 |