| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,168 |
2,150 |
$114K |
| D1110 |
Prophylaxis - adult |
885 |
871 |
$68K |
| D1120 |
Prophylaxis - child |
1,576 |
1,564 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
689 |
427 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
633 |
632 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,524 |
2,504 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
719 |
714 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,393 |
2,062 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,168 |
1,164 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,639 |
2,879 |
$22K |
| D4910 |
|
177 |
173 |
$13K |
| D0350 |
|
1,610 |
958 |
$11K |
| D2140 |
|
185 |
116 |
$9K |
| D9430 |
|
206 |
202 |
$6K |
| D9110 |
|
102 |
97 |
$6K |
| D2160 |
|
15 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
79 |
79 |
$938.00 |
| D1999 |
|
556 |
496 |
$85.00 |