| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
551 |
534 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
237 |
101 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
68 |
66 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
98 |
90 |
$8K |
| D1110 |
Prophylaxis - adult |
524 |
508 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
472 |
438 |
$2K |
| D2140 |
|
27 |
14 |
$2K |
| D0274 |
Bitewings - four radiographic images |
214 |
207 |
$35.41 |
| D0230 |
Intraoral - periapical each additional radiographic image |
186 |
182 |
$0.00 |