| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,967 |
3,966 |
$163K |
| D1120 |
Prophylaxis - child |
3,626 |
3,624 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,352 |
4,241 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
4,830 |
4,740 |
$56K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
675 |
484 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,611 |
3,610 |
$31K |
| D2140 |
|
476 |
318 |
$25K |
| D1110 |
Prophylaxis - adult |
312 |
311 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
202 |
200 |
$9K |
| D0274 |
Bitewings - four radiographic images |
179 |
179 |
$4K |
| D2330 |
|
33 |
13 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$2K |
| D9993 |
|
24 |
24 |
$2K |
| D1310 |
|
24 |
24 |
$1K |