| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,509 |
2,452 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
2,189 |
2,137 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,383 |
2,327 |
$64K |
| D8670 |
Periodic orthodontic treatment visit |
1,125 |
1,111 |
$43K |
| D0274 |
Bitewings - four radiographic images |
828 |
814 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
161 |
95 |
$16K |
| D0330 |
Panoramic radiographic image |
112 |
109 |
$8K |
| D1351 |
Sealant - per tooth |
116 |
26 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
223 |
215 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
150 |
145 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
15 |
$861.90 |