| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,673 |
1,468 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,616 |
1,393 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,267 |
1,115 |
$36K |
| D8670 |
Periodic orthodontic treatment visit |
436 |
406 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
227 |
105 |
$19K |
| D0274 |
Bitewings - four radiographic images |
236 |
217 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$1K |