| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,798 |
1,794 |
$102K |
| D1120 |
Prophylaxis - child |
2,012 |
2,008 |
$52K |
| D1206 |
Topical application of fluoride varnish |
1,985 |
1,982 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,293 |
1,289 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
225 |
225 |
$16K |
| D0274 |
Bitewings - four radiographic images |
367 |
367 |
$9K |
| D1351 |
Sealant - per tooth |
222 |
37 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
59 |
29 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
310 |
307 |
$4K |
| D0330 |
Panoramic radiographic image |
70 |
70 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
17 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
212 |
204 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$1K |