| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,185 |
2,159 |
$118K |
| D1120 |
Prophylaxis - child |
1,703 |
1,686 |
$63K |
| D1110 |
Prophylaxis - adult |
404 |
393 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,680 |
2,620 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,404 |
1,382 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,420 |
2,377 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
231 |
231 |
$15K |
| D2140 |
|
228 |
153 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
121 |
81 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
110 |
$5K |
| D1351 |
Sealant - per tooth |
195 |
76 |
$5K |
| D0272 |
Bitewings - two radiographic images |
197 |
196 |
$2K |