| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,106 |
5,711 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
4,016 |
3,546 |
$104K |
| D0274 |
Bitewings - four radiographic images |
5,472 |
4,345 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,178 |
5,758 |
$82K |
| D8670 |
Periodic orthodontic treatment visit |
1,025 |
798 |
$75K |
| D0330 |
Panoramic radiographic image |
2,741 |
2,215 |
$75K |
| D1351 |
Sealant - per tooth |
4,642 |
541 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
3,399 |
2,546 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
599 |
333 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
283 |
151 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
835 |
538 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
658 |
450 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
128 |
81 |
$8K |