| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,027 |
1,974 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,299 |
2,223 |
$63K |
| D1110 |
Prophylaxis - adult |
765 |
727 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,589 |
1,540 |
$32K |
| D0272 |
Bitewings - two radiographic images |
988 |
957 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
270 |
251 |
$15K |
| D1206 |
Topical application of fluoride varnish |
198 |
192 |
$5K |
| D2140 |
|
49 |
26 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
104 |
100 |
$2K |
| D1351 |
Sealant - per tooth |
49 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43 |
43 |
$704.96 |