| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,851 |
1,764 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,123 |
1,994 |
$56K |
| D1351 |
Sealant - per tooth |
1,218 |
624 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,019 |
958 |
$25K |
| D1206 |
Topical application of fluoride varnish |
788 |
761 |
$17K |
| D0274 |
Bitewings - four radiographic images |
427 |
395 |
$8K |
| D1110 |
Prophylaxis - adult |
221 |
200 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
276 |
258 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
851 |
782 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
757 |
671 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
44 |
30 |
$2K |
| D0272 |
Bitewings - two radiographic images |
204 |
190 |
$2K |
| D2140 |
|
44 |
26 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
53 |
$826.20 |
| D0602 |
|
456 |
439 |
$0.00 |
| D0601 |
|
374 |
364 |
$0.00 |