| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,159 |
2,080 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
1,989 |
1,921 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,987 |
1,916 |
$49K |
| D8670 |
Periodic orthodontic treatment visit |
200 |
191 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
416 |
295 |
$29K |
| D1351 |
Sealant - per tooth |
400 |
227 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
375 |
253 |
$19K |
| D0274 |
Bitewings - four radiographic images |
665 |
634 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
692 |
648 |
$4K |
| D0330 |
Panoramic radiographic image |
168 |
166 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
657 |
613 |
$2K |
| D0272 |
Bitewings - two radiographic images |
176 |
173 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32 |
31 |
$568.35 |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$261.70 |