| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,649 |
3,516 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
3,819 |
3,688 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,371 |
3,241 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,209 |
909 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,112 |
867 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,467 |
2,365 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,072 |
1,003 |
$24K |
| D4341 |
|
129 |
58 |
$20K |
| D8670 |
Periodic orthodontic treatment visit |
107 |
95 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
3,281 |
3,119 |
$19K |
| D1351 |
Sealant - per tooth |
210 |
157 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,856 |
2,728 |
$11K |
| D1110 |
Prophylaxis - adult |
288 |
286 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
496 |
474 |
$8K |
| D0330 |
Panoramic radiographic image |
286 |
284 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
189 |
$3K |
| D9110 |
|
14 |
13 |
$770.00 |
| D0272 |
Bitewings - two radiographic images |
41 |
39 |
$362.80 |