| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,580 |
1,576 |
$90K |
| D4910 |
|
1,170 |
1,169 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,057 |
2,512 |
$64K |
| D1110 |
Prophylaxis - adult |
751 |
748 |
$61K |
| D1120 |
Prophylaxis - child |
954 |
951 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,263 |
2,258 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,764 |
1,754 |
$20K |
| D2330 |
|
251 |
91 |
$19K |
| D9430 |
|
595 |
563 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
235 |
233 |
$13K |
| D4341 |
|
182 |
51 |
$13K |
| D1351 |
Sealant - per tooth |
252 |
65 |
$7K |
| D2160 |
|
65 |
33 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
60 |
$3K |
| D2161 |
|
27 |
15 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
12 |
$2K |
| D2331 |
|
20 |
12 |
$1K |
| D0350 |
|
45 |
40 |
$912.00 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
15 |
$180.00 |