| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
6,148 |
6,089 |
$2.20M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,205 |
1,201 |
$1.20M |
| D8660 |
|
2,038 |
1,980 |
$366K |
| D8680 |
|
660 |
653 |
$276K |
| D9310 |
|
350 |
330 |
$29K |
| D0340 |
|
365 |
345 |
$26K |
| D0330 |
Panoramic radiographic image |
279 |
279 |
$16K |
| D8703 |
|
13 |
13 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
632 |
632 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
106 |
106 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
114 |
114 |
$0.00 |
| D9920 |
|
14 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
643 |
643 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
99 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
154 |
82 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
49 |
49 |
$0.00 |
| D1351 |
Sealant - per tooth |
47 |
16 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
52 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
251 |
226 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
188 |
188 |
$0.00 |
| D1110 |
Prophylaxis - adult |
273 |
273 |
$0.00 |
| D1120 |
Prophylaxis - child |
447 |
447 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
260 |
256 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
133 |
100 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$0.00 |