| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,878 |
2,798 |
$133K |
| D1110 |
Prophylaxis - adult |
1,726 |
1,676 |
$73K |
| D0330 |
Panoramic radiographic image |
1,328 |
1,276 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,579 |
2,512 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,814 |
1,763 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,300 |
1,261 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,040 |
1,973 |
$29K |
| D1206 |
Topical application of fluoride varnish |
2,003 |
1,975 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
381 |
273 |
$22K |
| D2140 |
|
475 |
370 |
$21K |
| D0272 |
Bitewings - two radiographic images |
633 |
612 |
$11K |
| D1351 |
Sealant - per tooth |
92 |
26 |
$2K |
| D1999 |
|
39 |
38 |
$0.00 |