| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,621 |
3,426 |
$751K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
33 |
28 |
$28K |
| D8999 |
|
287 |
275 |
$13K |
| D8680 |
|
97 |
85 |
$12K |
| D1120 |
Prophylaxis - child |
100 |
97 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
129 |
123 |
$4K |
| D1206 |
Topical application of fluoride varnish |
100 |
97 |
$3K |
| D0274 |
Bitewings - four radiographic images |
83 |
80 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
18 |
$963.00 |
| D0220 |
Intraoral - periapical first radiographic image |
161 |
142 |
$890.40 |
| D1110 |
Prophylaxis - adult |
19 |
19 |
$779.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
156 |
137 |
$638.40 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
23 |
$526.25 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
14 |
$493.60 |
| D0272 |
Bitewings - two radiographic images |
30 |
28 |
$272.60 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$180.80 |
| D1999 |
|
123 |
109 |
$0.00 |