| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,839 |
2,768 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,986 |
2,917 |
$45K |
| D1120 |
Prophylaxis - child |
1,954 |
1,906 |
$38K |
| D1351 |
Sealant - per tooth |
1,337 |
324 |
$28K |
| D1110 |
Prophylaxis - adult |
753 |
731 |
$24K |
| D0330 |
Panoramic radiographic image |
309 |
302 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
185 |
137 |
$10K |
| D0272 |
Bitewings - two radiographic images |
830 |
809 |
$8K |
| D0274 |
Bitewings - four radiographic images |
411 |
395 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166 |
160 |
$4K |
| D2140 |
|
36 |
24 |
$1K |