| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
1,260 |
1,197 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
834 |
799 |
$23K |
| D1120 |
Prophylaxis - child |
463 |
440 |
$22K |
| D1110 |
Prophylaxis - adult |
329 |
305 |
$21K |
| D0274 |
Bitewings - four radiographic images |
333 |
320 |
$14K |
| D8670 |
Periodic orthodontic treatment visit |
53 |
50 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
91 |
39 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
301 |
287 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
213 |
202 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
41 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$650.00 |