| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
492 |
445 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
260 |
234 |
$13K |
| D1120 |
Prophylaxis - child |
237 |
221 |
$10K |
| D1206 |
Topical application of fluoride varnish |
249 |
232 |
$8K |
| D0274 |
Bitewings - four radiographic images |
262 |
249 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
201 |
187 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
359 |
328 |
$3K |
| D1110 |
Prophylaxis - adult |
149 |
141 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
363 |
296 |
$2K |
| D0350 |
|
97 |
87 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
37 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
45 |
38 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
42 |
35 |
$595.00 |
| D4355 |
|
20 |
13 |
$420.00 |
| D0601 |
|
97 |
89 |
$370.00 |
| D9210 |
|
20 |
15 |
$102.50 |
| D9310 |
|
53 |
43 |
$40.00 |
| D9215 |
|
19 |
14 |
$0.00 |