| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,563 |
2,458 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,542 |
2,437 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,120 |
2,031 |
$58K |
| D8670 |
Periodic orthodontic treatment visit |
204 |
181 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
376 |
226 |
$26K |
| D1351 |
Sealant - per tooth |
378 |
199 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,290 |
1,215 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,463 |
2,348 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,398 |
2,289 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
81 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
232 |
222 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
35 |
$4K |
| D0272 |
Bitewings - two radiographic images |
260 |
251 |
$2K |