| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,597 |
2,390 |
$59K |
| D1110 |
Prophylaxis - adult |
1,324 |
1,178 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,774 |
2,508 |
$42K |
| D1120 |
Prophylaxis - child |
1,695 |
1,538 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,869 |
2,594 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
229 |
196 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
102 |
53 |
$5K |
| D1999 |
|
814 |
670 |
$4K |
| D0330 |
Panoramic radiographic image |
116 |
98 |
$4K |
| D0240 |
|
450 |
203 |
$3K |
| D1351 |
Sealant - per tooth |
69 |
14 |
$2K |
| D1206 |
Topical application of fluoride varnish |
78 |
75 |
$2K |
| D0274 |
Bitewings - four radiographic images |
17 |
15 |
$152.73 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$93.56 |