| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,583 |
2,443 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
2,227 |
2,112 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,233 |
2,099 |
$57K |
| D8670 |
Periodic orthodontic treatment visit |
215 |
200 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
266 |
178 |
$17K |
| D0274 |
Bitewings - four radiographic images |
923 |
858 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,385 |
2,251 |
$13K |
| D1351 |
Sealant - per tooth |
202 |
78 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,290 |
2,163 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
113 |
87 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
171 |
148 |
$4K |
| D0272 |
Bitewings - two radiographic images |
369 |
347 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
48 |
17 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$1K |