| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
705 |
343 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
472 |
467 |
$43K |
| D1206 |
Topical application of fluoride varnish |
295 |
292 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
93 |
$11K |
| D2140 |
|
88 |
64 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
168 |
159 |
$4K |
| D2160 |
|
61 |
46 |
$3K |
| D1120 |
Prophylaxis - child |
260 |
258 |
$2K |
| D1110 |
Prophylaxis - adult |
45 |
43 |
$1K |
| D0274 |
Bitewings - four radiographic images |
96 |
94 |
$260.95 |
| D0230 |
Intraoral - periapical each additional radiographic image |
139 |
45 |
$32.28 |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$0.00 |