| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
527 |
512 |
$22K |
| D1120 |
Prophylaxis - child |
671 |
657 |
$20K |
| D1206 |
Topical application of fluoride varnish |
514 |
502 |
$11K |
| D0274 |
Bitewings - four radiographic images |
216 |
211 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
156 |
155 |
$4K |
| D0330 |
Panoramic radiographic image |
65 |
63 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
33 |
26 |
$3K |
| D1351 |
Sealant - per tooth |
73 |
18 |
$2K |
| D2140 |
|
25 |
17 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
108 |
102 |
$1K |