| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
317 |
311 |
$7K |
| D1120 |
Prophylaxis - child |
232 |
228 |
$5K |
| D1206 |
Topical application of fluoride varnish |
193 |
189 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
315 |
307 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
30 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
142 |
139 |
$1K |
| D1110 |
Prophylaxis - adult |
28 |
26 |
$906.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
361 |
272 |
$817.83 |
| D1208 |
Topical application of fluoride, excluding varnish |
62 |
60 |
$768.50 |
| D0274 |
Bitewings - four radiographic images |
28 |
27 |
$386.04 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$233.31 |