| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
12,041 |
11,963 |
$3.23M |
| D0340 |
|
7,242 |
7,238 |
$308K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
243 |
243 |
$234K |
| D0330 |
Panoramic radiographic image |
8,627 |
8,623 |
$226K |
| D8660 |
|
7,400 |
7,397 |
$212K |
| D0350 |
|
9,396 |
9,385 |
$101K |
| D8680 |
|
354 |
336 |
$57K |
| D0470 |
|
810 |
809 |
$24K |
| D1120 |
Prophylaxis - child |
425 |
425 |
$15K |
| D1351 |
Sealant - per tooth |
248 |
81 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
386 |
386 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
656 |
656 |
$8K |
| D1110 |
Prophylaxis - adult |
193 |
193 |
$8K |
| D0272 |
Bitewings - two radiographic images |
562 |
562 |
$7K |
| D9310 |
|
157 |
157 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
254 |
254 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
47 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
18 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
13 |
$990.18 |
| D1330 |
|
37 |
37 |
$0.00 |