| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,994 |
2,668 |
$76K |
| D1351 |
Sealant - per tooth |
2,051 |
242 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,543 |
1,318 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
505 |
248 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,086 |
918 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,526 |
1,343 |
$21K |
| D8670 |
Periodic orthodontic treatment visit |
260 |
201 |
$17K |
| D1206 |
Topical application of fluoride varnish |
808 |
687 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
420 |
377 |
$14K |
| D0330 |
Panoramic radiographic image |
359 |
305 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
454 |
373 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
50 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
268 |
218 |
$2K |