| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,928 |
1,840 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
1,713 |
1,643 |
$48K |
| D1351 |
Sealant - per tooth |
542 |
329 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,153 |
1,096 |
$30K |
| D0274 |
Bitewings - four radiographic images |
596 |
570 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
326 |
304 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,131 |
1,052 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
82 |
69 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
996 |
921 |
$4K |
| D0272 |
Bitewings - two radiographic images |
369 |
342 |
$4K |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$574.00 |