| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
825 |
791 |
$19K |
| D0272 |
Bitewings - two radiographic images |
700 |
674 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
549 |
529 |
$9K |
| D1351 |
Sealant - per tooth |
486 |
50 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
433 |
415 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
555 |
532 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
756 |
728 |
$5K |
| D1120 |
Prophylaxis - child |
227 |
216 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
825 |
721 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
89 |
46 |
$2K |
| D2140 |
|
57 |
26 |
$1K |