| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
6,028 |
6,008 |
$1.70M |
| D0340 |
|
6,427 |
6,404 |
$320K |
| D0140 |
Limited oral evaluation - problem focused |
7,056 |
7,033 |
$245K |
| D0330 |
Panoramic radiographic image |
7,575 |
7,555 |
$222K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
206 |
206 |
$211K |
| D0350 |
|
7,303 |
5,113 |
$144K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
557 |
287 |
$66K |
| D8680 |
|
140 |
70 |
$44K |
| D9430 |
|
1,260 |
1,094 |
$40K |
| D7240 |
Removal of impacted tooth - completely bony |
172 |
74 |
$38K |
| D0470 |
|
396 |
396 |
$18K |
| D7230 |
|
50 |
28 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
119 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
37 |
$5K |
| D8704 |
|
12 |
12 |
$2K |
| D8703 |
|
12 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
50 |
$2K |
| D7261 |
|
18 |
13 |
$560.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
57 |
31 |
$230.85 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$210.00 |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
17 |
$204.00 |