| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,578 |
2,574 |
$142K |
| D1110 |
Prophylaxis - adult |
1,038 |
1,038 |
$92K |
| D1120 |
Prophylaxis - child |
1,938 |
1,933 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
967 |
966 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,118 |
1,115 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
325 |
324 |
$21K |
| D1351 |
Sealant - per tooth |
425 |
114 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
913 |
418 |
$4K |
| D0272 |
Bitewings - two radiographic images |
230 |
230 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
117 |
114 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
15 |
$1K |
| D0350 |
|
147 |
100 |
$1K |