| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,288 |
2,202 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
2,051 |
1,972 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,067 |
1,990 |
$52K |
| D1351 |
Sealant - per tooth |
308 |
101 |
$16K |
| D0274 |
Bitewings - four radiographic images |
706 |
683 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
69 |
41 |
$4K |
| D2140 |
|
63 |
38 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
85 |
78 |
$2K |
| D0272 |
Bitewings - two radiographic images |
126 |
112 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
46 |
$290.84 |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
12 |
$62.72 |