| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
1,978 |
1,826 |
$55K |
| D1110 |
Prophylaxis - adult |
825 |
726 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,593 |
1,426 |
$33K |
| D1120 |
Prophylaxis - child |
765 |
724 |
$32K |
| D0274 |
Bitewings - four radiographic images |
312 |
308 |
$7K |
| D1206 |
Topical application of fluoride varnish |
181 |
165 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
174 |
$6K |
| D2140 |
|
55 |
26 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
78 |
$958.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$242.00 |