| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,098 |
3,097 |
$168K |
| D1120 |
Prophylaxis - child |
3,869 |
3,861 |
$141K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,470 |
3,465 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,534 |
1,534 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,556 |
2,620 |
$26K |
| D1351 |
Sealant - per tooth |
1,054 |
277 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
472 |
469 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
320 |
317 |
$18K |
| D9993 |
|
145 |
145 |
$8K |
| D1310 |
|
170 |
170 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
87 |
42 |
$6K |
| D1320 |
|
624 |
624 |
$5K |
| D0272 |
Bitewings - two radiographic images |
410 |
410 |
$5K |
| D1206 |
Topical application of fluoride varnish |
155 |
154 |
$3K |
| D2140 |
|
58 |
27 |
$3K |
| D9430 |
|
40 |
39 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
49 |
$556.00 |