| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,421 |
2,421 |
$61K |
| D1110 |
Prophylaxis - adult |
1,378 |
1,378 |
$37K |
| D1120 |
Prophylaxis - child |
998 |
998 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,348 |
2,344 |
$23K |
| D0272 |
Bitewings - two radiographic images |
2,127 |
2,127 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,624 |
2,611 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,230 |
1,230 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
96 |
52 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
135 |
135 |
$4K |
| D0601 |
|
320 |
320 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
78 |
78 |
$3K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$312.00 |
| D1330 |
|
724 |
718 |
$0.00 |