| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,391 |
1,382 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
985 |
979 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
931 |
925 |
$42K |
| D1120 |
Prophylaxis - child |
825 |
818 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
366 |
162 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,343 |
1,342 |
$13K |
| D1110 |
Prophylaxis - adult |
131 |
131 |
$12K |
| D4910 |
|
138 |
136 |
$11K |
| D0350 |
|
1,508 |
466 |
$10K |
| D0274 |
Bitewings - four radiographic images |
390 |
390 |
$8K |
| D1206 |
Topical application of fluoride varnish |
524 |
523 |
$8K |
| D0272 |
Bitewings - two radiographic images |
627 |
621 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
540 |
535 |
$7K |
| D2140 |
|
41 |
26 |
$2K |
| D2160 |
|
17 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
52 |
$414.60 |