| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,460 |
2,424 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
2,451 |
2,397 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,380 |
2,347 |
$62K |
| D2140 |
|
278 |
183 |
$11K |
| D0272 |
Bitewings - two radiographic images |
917 |
901 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
162 |
105 |
$8K |
| D0274 |
Bitewings - four radiographic images |
93 |
93 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
53 |
$872.64 |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
40 |
$242.73 |
| D1999 |
|
132 |
116 |
$0.00 |