| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,127 |
2,118 |
$52K |
| D1110 |
Prophylaxis - adult |
1,284 |
1,279 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,641 |
1,622 |
$41K |
| D1999 |
|
2,543 |
2,365 |
$25K |
| D1120 |
Prophylaxis - child |
661 |
658 |
$19K |
| D0274 |
Bitewings - four radiographic images |
613 |
610 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
835 |
811 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,115 |
412 |
$4K |
| D1351 |
Sealant - per tooth |
81 |
25 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
70 |
69 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
25 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$1K |
| D0330 |
Panoramic radiographic image |
58 |
56 |
$692.87 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$618.21 |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$492.01 |