| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,001 |
1,990 |
$241K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,122 |
592 |
$56K |
| D2140 |
|
230 |
146 |
$13K |
| D1351 |
Sealant - per tooth |
211 |
43 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
54 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,551 |
1,532 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
36 |
$2K |
| D1120 |
Prophylaxis - child |
1,387 |
1,382 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,376 |
1,327 |
$1K |
| D1206 |
Topical application of fluoride varnish |
1,700 |
1,699 |
$788.22 |
| D0274 |
Bitewings - four radiographic images |
877 |
870 |
$469.38 |
| D0210 |
Intraoral - complete series of radiographic images |
342 |
342 |
$342.73 |
| D1110 |
Prophylaxis - adult |
682 |
675 |
$240.34 |
| D0272 |
Bitewings - two radiographic images |
330 |
328 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
18 |
$0.00 |