| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,155 |
3,091 |
$231K |
| D0220 |
Intraoral - periapical first radiographic image |
451 |
418 |
$30K |
| D1120 |
Prophylaxis - child |
2,893 |
2,836 |
$29K |
| D1206 |
Topical application of fluoride varnish |
3,361 |
3,295 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,148 |
1,109 |
$24K |
| D0274 |
Bitewings - four radiographic images |
130 |
125 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
115 |
55 |
$4K |
| D2140 |
|
31 |
12 |
$3K |
| D1110 |
Prophylaxis - adult |
86 |
83 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
41 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$983.66 |
| D0330 |
Panoramic radiographic image |
88 |
85 |
$553.35 |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
22 |
$0.00 |
| D1351 |
Sealant - per tooth |
45 |
13 |
$0.00 |