| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,233 |
2,233 |
$62K |
| D1110 |
Prophylaxis - adult |
1,230 |
1,230 |
$43K |
| D1120 |
Prophylaxis - child |
1,334 |
1,334 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,473 |
2,472 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,138 |
1,138 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,774 |
2,094 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,116 |
1,115 |
$20K |
| D2140 |
|
305 |
139 |
$12K |
| D0330 |
Panoramic radiographic image |
263 |
263 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
191 |
107 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
254 |
254 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
637 |
621 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
106 |
$3K |