| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
835 |
788 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
894 |
842 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
696 |
652 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
224 |
129 |
$16K |
| D0274 |
Bitewings - four radiographic images |
311 |
285 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
210 |
205 |
$5K |
| D2140 |
|
61 |
42 |
$3K |
| D1206 |
Topical application of fluoride varnish |
105 |
105 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
436 |
402 |
$2K |
| D0272 |
Bitewings - two radiographic images |
209 |
199 |
$2K |
| D1110 |
Prophylaxis - adult |
63 |
57 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
272 |
242 |
$1K |
| D1351 |
Sealant - per tooth |
26 |
18 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
29 |
$405.00 |