| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,279 |
2,279 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,858 |
2,858 |
$58K |
| D1110 |
Prophylaxis - adult |
1,230 |
1,230 |
$54K |
| D0330 |
Panoramic radiographic image |
1,119 |
1,119 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,461 |
2,461 |
$36K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
395 |
201 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
844 |
$25K |
| D0274 |
Bitewings - four radiographic images |
848 |
848 |
$25K |
| D1206 |
Topical application of fluoride varnish |
942 |
942 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
334 |
332 |
$10K |
| D2940 |
|
176 |
76 |
$8K |
| D0272 |
Bitewings - two radiographic images |
349 |
349 |
$6K |
| D0601 |
|
209 |
209 |
$2K |
| D2140 |
|
29 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
92 |
92 |
$1K |