| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
287 |
281 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
443 |
429 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
200 |
196 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
178 |
$4K |
| D0274 |
Bitewings - four radiographic images |
227 |
213 |
$3K |
| D1110 |
Prophylaxis - adult |
99 |
92 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
323 |
270 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
374 |
355 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$963.00 |