| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,430 |
2,280 |
$91K |
| D8670 |
Periodic orthodontic treatment visit |
1,348 |
1,195 |
$80K |
| D1206 |
Topical application of fluoride varnish |
3,471 |
3,263 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,634 |
2,491 |
$68K |
| D9248 |
|
170 |
158 |
$32K |
| D1110 |
Prophylaxis - adult |
462 |
447 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
124 |
71 |
$15K |
| D1351 |
Sealant - per tooth |
383 |
77 |
$13K |
| D0272 |
Bitewings - two radiographic images |
858 |
826 |
$12K |
| D1330 |
|
1,443 |
1,349 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
130 |
119 |
$6K |
| D0240 |
|
246 |
239 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
462 |
448 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
27 |
$4K |
| D8660 |
|
14 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
297 |
290 |
$2K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$1K |
| D0274 |
Bitewings - four radiographic images |
40 |
40 |
$880.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
12 |
$480.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$299.00 |