| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
357 |
354 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,599 |
718 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
408 |
374 |
$5K |
| D1120 |
Prophylaxis - child |
130 |
129 |
$4K |
| D0274 |
Bitewings - four radiographic images |
135 |
135 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
31 |
13 |
$2K |
| D9430 |
|
62 |
57 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
147 |
146 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
27 |
$1K |
| D2140 |
|
23 |
13 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$1K |
| D0350 |
|
130 |
69 |
$934.80 |