| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,972 |
1,927 |
$217K |
| D1120 |
Prophylaxis - child |
1,857 |
1,817 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,477 |
1,448 |
$18K |
| D1351 |
Sealant - per tooth |
657 |
78 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
261 |
168 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,303 |
1,249 |
$9K |
| D1206 |
Topical application of fluoride varnish |
1,869 |
1,837 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
70 |
$6K |
| D2140 |
|
47 |
37 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,127 |
1,075 |
$4K |
| D0274 |
Bitewings - four radiographic images |
79 |
78 |
$599.90 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$0.00 |