| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,228 |
2,226 |
$133K |
| D1120 |
Prophylaxis - child |
1,824 |
1,821 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,505 |
2,667 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,778 |
1,776 |
$37K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
530 |
265 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
474 |
473 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,905 |
1,902 |
$22K |
| D2160 |
|
272 |
130 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
318 |
317 |
$15K |
| D1110 |
Prophylaxis - adult |
158 |
155 |
$13K |
| D1206 |
Topical application of fluoride varnish |
561 |
559 |
$11K |
| D0350 |
|
546 |
276 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
370 |
336 |
$4K |
| D9430 |
|
55 |
52 |
$2K |
| D1320 |
|
42 |
42 |
$735.00 |
| D1310 |
|
13 |
13 |
$598.00 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$321.00 |
| D0603 |
|
13 |
13 |
$195.00 |
| D1330 |
|
2,274 |
2,268 |
$0.00 |