| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,240 |
4,211 |
$336K |
| D1351 |
Sealant - per tooth |
8,030 |
1,221 |
$190K |
| D1120 |
Prophylaxis - child |
4,246 |
4,220 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
2,983 |
2,956 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
310 |
309 |
$36K |
| D1206 |
Topical application of fluoride varnish |
4,614 |
4,583 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,888 |
1,874 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
162 |
86 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,884 |
2,742 |
$8K |
| D0274 |
Bitewings - four radiographic images |
819 |
812 |
$6K |
| D0330 |
Panoramic radiographic image |
429 |
423 |
$3K |
| D2140 |
|
22 |
14 |
$1K |
| D1110 |
Prophylaxis - adult |
214 |
210 |
$500.40 |