| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
586 |
576 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
531 |
498 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
293 |
287 |
$19K |
| D1110 |
Prophylaxis - adult |
303 |
295 |
$17K |
| D0274 |
Bitewings - four radiographic images |
678 |
661 |
$14K |
| D1351 |
Sealant - per tooth |
1,220 |
116 |
$14K |
| D1120 |
Prophylaxis - child |
262 |
253 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
929 |
870 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
116 |
52 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
181 |
180 |
$2K |
| D1206 |
Topical application of fluoride varnish |
367 |
355 |
$1K |
| D1999 |
|
25 |
21 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
393 |
319 |
$845.62 |