| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,615 |
2,606 |
$148K |
| D1120 |
Prophylaxis - child |
2,745 |
2,737 |
$109K |
| D2140 |
|
874 |
491 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,785 |
1,780 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,140 |
3,132 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,477 |
3,531 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
314 |
314 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
265 |
202 |
$18K |
| D1351 |
Sealant - per tooth |
471 |
115 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,241 |
1,231 |
$14K |
| D1110 |
Prophylaxis - adult |
115 |
115 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
87 |
84 |
$1K |