| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,927 |
2,784 |
$69K |
| D0145 |
Oral evaluation for a patient under three years of age |
547 |
532 |
$68K |
| D1351 |
Sealant - per tooth |
2,739 |
476 |
$60K |
| D1120 |
Prophylaxis - child |
1,941 |
1,841 |
$58K |
| D1110 |
Prophylaxis - adult |
1,052 |
994 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,071 |
2,913 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,478 |
1,403 |
$36K |
| D0330 |
Panoramic radiographic image |
295 |
283 |
$16K |
| D0272 |
Bitewings - two radiographic images |
488 |
438 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
45 |
26 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
41 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
26 |
25 |
$325.35 |
| D0601 |
|
1,248 |
1,202 |
$0.02 |
| D0603 |
|
985 |
942 |
$0.01 |
| D0602 |
|
1,311 |
1,250 |
$0.00 |