| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
691 |
669 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
469 |
456 |
$13K |
| D1206 |
Topical application of fluoride varnish |
509 |
496 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
193 |
184 |
$8K |
| D0274 |
Bitewings - four radiographic images |
188 |
183 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
64 |
36 |
$6K |
| D0330 |
Panoramic radiographic image |
65 |
64 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
71 |
$3K |
| D2140 |
|
32 |
26 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
132 |
94 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$272.61 |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$255.30 |