| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,438 |
2,432 |
$59K |
| D1110 |
Prophylaxis - adult |
1,425 |
1,419 |
$41K |
| D1120 |
Prophylaxis - child |
994 |
994 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,093 |
2,070 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,934 |
1,931 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,265 |
2,254 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,293 |
1,293 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
219 |
124 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
244 |
243 |
$9K |
| D0330 |
Panoramic radiographic image |
223 |
223 |
$5K |
| D0601 |
|
164 |
164 |
$2K |
| D1330 |
|
888 |
864 |
$0.00 |