| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,935 |
1,932 |
$85K |
| D1120 |
Prophylaxis - child |
2,084 |
2,077 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,362 |
1,360 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,167 |
2,161 |
$21K |
| D1351 |
Sealant - per tooth |
764 |
225 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,769 |
1,875 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
132 |
66 |
$9K |
| D2140 |
|
47 |
29 |
$3K |
| D0350 |
|
203 |
92 |
$2K |
| D0272 |
Bitewings - two radiographic images |
186 |
186 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
23 |
23 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$788.00 |