| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,160 |
1,062 |
$37K |
| D1206 |
Topical application of fluoride varnish |
817 |
765 |
$24K |
| D1120 |
Prophylaxis - child |
470 |
457 |
$15K |
| D1110 |
Prophylaxis - adult |
245 |
236 |
$11K |
| D0274 |
Bitewings - four radiographic images |
377 |
333 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
63 |
24 |
$4K |
| D4346 |
|
19 |
19 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
84 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
29 |
$1K |
| D1320 |
|
49 |
45 |
$577.40 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$552.00 |
| D1330 |
|
804 |
754 |
$454.00 |