| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
9,507 |
9,194 |
$1.23M |
| D0340 |
|
1,482 |
1,478 |
$61K |
| D0330 |
Panoramic radiographic image |
1,823 |
1,817 |
$49K |
| D0470 |
|
1,748 |
1,743 |
$45K |
| D8660 |
|
1,312 |
1,307 |
$37K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
40 |
40 |
$35K |
| D0350 |
|
1,950 |
1,944 |
$17K |
| D1120 |
Prophylaxis - child |
150 |
150 |
$5K |
| D8680 |
|
25 |
25 |
$4K |
| D1206 |
Topical application of fluoride varnish |
158 |
157 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
120 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
72 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
106 |
106 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
94 |
94 |
$547.96 |
| D0120 |
Periodic oral evaluation - established patient |
30 |
30 |
$498.92 |
| D9995 |
|
13 |
13 |
$234.80 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$157.85 |
| D1999 |
|
1,013 |
1,004 |
$0.00 |