| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,069 |
4,869 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
4,369 |
4,195 |
$121K |
| D1351 |
Sealant - per tooth |
1,428 |
935 |
$110K |
| D8670 |
Periodic orthodontic treatment visit |
476 |
397 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,203 |
3,085 |
$83K |
| D0274 |
Bitewings - four radiographic images |
1,538 |
1,485 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
333 |
291 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,982 |
2,865 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
593 |
580 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,739 |
2,639 |
$11K |
| D0272 |
Bitewings - two radiographic images |
955 |
931 |
$10K |
| D2140 |
|
82 |
74 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
100 |
97 |
$2K |
| D1999 |
|
76 |
59 |
$0.00 |