| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
94 |
87 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
46 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
80 |
75 |
$2K |
| D1110 |
Prophylaxis - adult |
66 |
58 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
37 |
35 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
60 |
58 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
34 |
31 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
102 |
97 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
89 |
57 |
$907.46 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$340.80 |