| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,034 |
3,880 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
4,515 |
4,335 |
$120K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
781 |
608 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,517 |
1,445 |
$38K |
| D0274 |
Bitewings - four radiographic images |
2,125 |
2,055 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
628 |
507 |
$27K |
| D8670 |
Periodic orthodontic treatment visit |
99 |
96 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,480 |
2,388 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
414 |
407 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,043 |
1,972 |
$8K |
| D0272 |
Bitewings - two radiographic images |
556 |
530 |
$5K |
| D1351 |
Sealant - per tooth |
51 |
34 |
$4K |
| D1110 |
Prophylaxis - adult |
130 |
129 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
74 |
$1K |