| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,584 |
1,567 |
$50K |
| D1110 |
Prophylaxis - adult |
1,219 |
1,204 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,967 |
1,946 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,900 |
1,876 |
$36K |
| D2140 |
|
651 |
374 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,082 |
1,071 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
376 |
251 |
$27K |
| D0330 |
Panoramic radiographic image |
404 |
399 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
776 |
766 |
$15K |
| D0272 |
Bitewings - two radiographic images |
852 |
839 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
496 |
489 |
$13K |
| D2740 |
Crown - porcelain/ceramic |
20 |
12 |
$10K |
| D1351 |
Sealant - per tooth |
257 |
73 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$296.48 |