| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,176 |
2,169 |
$121K |
| D1110 |
Prophylaxis - adult |
825 |
824 |
$70K |
| D1120 |
Prophylaxis - child |
1,745 |
1,735 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,009 |
2,770 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,866 |
2,853 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
727 |
726 |
$33K |
| D1351 |
Sealant - per tooth |
1,458 |
288 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,259 |
1,253 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
372 |
370 |
$22K |
| D2330 |
|
222 |
120 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
616 |
577 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
80 |
42 |
$5K |
| D0272 |
Bitewings - two radiographic images |
318 |
315 |
$4K |