| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
314 |
311 |
$12K |
| D1120 |
Prophylaxis - child |
237 |
234 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,479 |
533 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
462 |
457 |
$5K |
| D0274 |
Bitewings - four radiographic images |
183 |
178 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
218 |
185 |
$3K |
| D2140 |
|
43 |
26 |
$2K |
| D1206 |
Topical application of fluoride varnish |
169 |
169 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
14 |
$2K |
| D9430 |
|
31 |
27 |
$992.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$924.00 |
| D0350 |
|
39 |
13 |
$355.20 |