| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,274 |
1,264 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
1,615 |
1,610 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,243 |
1,235 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,383 |
2,175 |
$41K |
| D1120 |
Prophylaxis - child |
950 |
945 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,237 |
1,229 |
$25K |
| D9430 |
|
722 |
657 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
248 |
245 |
$11K |
| D8670 |
Periodic orthodontic treatment visit |
27 |
27 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
56 |
25 |
$4K |
| D0330 |
Panoramic radiographic image |
112 |
110 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
183 |
182 |
$2K |
| D0272 |
Bitewings - two radiographic images |
119 |
119 |
$1K |