| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,681 |
2,555 |
$217K |
| D0120 |
Periodic oral evaluation - established patient |
1,605 |
1,543 |
$74K |
| D0274 |
Bitewings - four radiographic images |
1,023 |
957 |
$40K |
| D0999 |
Unspecified diagnostic procedure, by report |
367 |
354 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,909 |
1,814 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
37 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
95 |
94 |
$3K |
| D2140 |
|
26 |
26 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,238 |
1,168 |
$1K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$1K |
| D0603 |
|
1,107 |
1,049 |
$0.00 |
| D1330 |
|
2,261 |
2,093 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,737 |
1,290 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
59 |
59 |
$0.00 |