| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,911 |
2,807 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
1,524 |
1,489 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,930 |
1,821 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,024 |
2,889 |
$48K |
| D0330 |
Panoramic radiographic image |
805 |
791 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,229 |
1,161 |
$33K |
| D8670 |
Periodic orthodontic treatment visit |
122 |
120 |
$15K |
| D1351 |
Sealant - per tooth |
532 |
78 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
260 |
254 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
126 |
126 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
55 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
40 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
38 |
$5K |