| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,998 |
4,823 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
4,049 |
3,925 |
$132K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,897 |
4,728 |
$131K |
| D8670 |
Periodic orthodontic treatment visit |
1,834 |
1,770 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
704 |
275 |
$70K |
| D1351 |
Sealant - per tooth |
628 |
167 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
334 |
290 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
250 |
243 |
$15K |
| D0272 |
Bitewings - two radiographic images |
431 |
409 |
$12K |
| D0274 |
Bitewings - four radiographic images |
283 |
259 |
$12K |
| D0330 |
Panoramic radiographic image |
152 |
142 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
39 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
95 |
93 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$2K |