| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,902 |
2,766 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
2,588 |
2,464 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,743 |
2,613 |
$69K |
| D8670 |
Periodic orthodontic treatment visit |
211 |
204 |
$48K |
| D1351 |
Sealant - per tooth |
661 |
313 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
464 |
311 |
$30K |
| D0274 |
Bitewings - four radiographic images |
920 |
879 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
192 |
143 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,262 |
1,193 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
227 |
220 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,202 |
1,131 |
$4K |
| D0272 |
Bitewings - two radiographic images |
336 |
328 |
$3K |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$293.70 |