| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0160 |
|
1,241 |
1,228 |
$54K |
| D1110 |
Prophylaxis - adult |
1,072 |
1,054 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
687 |
676 |
$27K |
| D9110 |
|
1,029 |
936 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,551 |
1,525 |
$19K |
| D4355 |
|
245 |
240 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
506 |
498 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
746 |
738 |
$9K |
| D0274 |
Bitewings - four radiographic images |
514 |
511 |
$8K |
| D0170 |
|
408 |
404 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
184 |
$3K |
| D0330 |
Panoramic radiographic image |
73 |
73 |
$3K |
| D2931 |
|
28 |
24 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
31 |
27 |
$1K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$218.20 |