| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
839 |
795 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
784 |
750 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
723 |
681 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
252 |
234 |
$6K |
| D0274 |
Bitewings - four radiographic images |
296 |
285 |
$5K |
| D1110 |
Prophylaxis - adult |
157 |
156 |
$4K |
| D1351 |
Sealant - per tooth |
78 |
32 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
206 |
203 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
758 |
734 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
63 |
46 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
668 |
648 |
$2K |