| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,491 |
1,359 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
2,163 |
1,988 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,296 |
2,117 |
$34K |
| D1110 |
Prophylaxis - adult |
717 |
673 |
$25K |
| D0272 |
Bitewings - two radiographic images |
580 |
517 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
122 |
48 |
$7K |
| D2140 |
|
143 |
68 |
$6K |
| D0274 |
Bitewings - four radiographic images |
204 |
190 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
38 |
38 |
$1K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$642.00 |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
15 |
$167.50 |
| D1330 |
|
129 |
124 |
$0.00 |