| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
4,595 |
1,112 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
279 |
279 |
$15K |
| D1120 |
Prophylaxis - child |
409 |
409 |
$14K |
| D0272 |
Bitewings - two radiographic images |
950 |
944 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
172 |
171 |
$9K |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$2K |
| D1206 |
Topical application of fluoride varnish |
154 |
154 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$110.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |