| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,783 |
3,760 |
$213K |
| D1120 |
Prophylaxis - child |
4,298 |
4,274 |
$170K |
| D0274 |
Bitewings - four radiographic images |
3,341 |
3,326 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,655 |
3,638 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,239 |
4,199 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
276 |
185 |
$18K |
| D1351 |
Sealant - per tooth |
564 |
112 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
86 |
86 |
$6K |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$160.00 |