| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,691 |
1,607 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,697 |
1,615 |
$47K |
| D8670 |
Periodic orthodontic treatment visit |
182 |
167 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
764 |
726 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
136 |
116 |
$15K |
| D0274 |
Bitewings - four radiographic images |
563 |
540 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
416 |
385 |
$6K |
| D0330 |
Panoramic radiographic image |
204 |
180 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
50 |
$810.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$625.95 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
41 |
$218.40 |
| D1999 |
|
40 |
38 |
$0.00 |