| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,545 |
5,516 |
$294K |
| D1120 |
Prophylaxis - child |
6,200 |
6,162 |
$230K |
| D1351 |
Sealant - per tooth |
5,913 |
1,411 |
$151K |
| D0274 |
Bitewings - four radiographic images |
3,991 |
3,968 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,221 |
6,190 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
1,254 |
1,250 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
490 |
488 |
$28K |
| D0350 |
|
1,274 |
626 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,583 |
942 |
$12K |
| D2140 |
|
204 |
140 |
$11K |
| D0272 |
Bitewings - two radiographic images |
589 |
586 |
$7K |
| D0330 |
Panoramic radiographic image |
118 |
118 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
12 |
$1K |