| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,606 |
1,591 |
$61K |
| D1120 |
Prophylaxis - child |
2,017 |
1,995 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
596 |
301 |
$38K |
| D0274 |
Bitewings - four radiographic images |
945 |
932 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,353 |
1,719 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,988 |
1,966 |
$16K |
| D2160 |
|
90 |
50 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
96 |
95 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
83 |
82 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
255 |
251 |
$3K |
| D0272 |
Bitewings - two radiographic images |
163 |
163 |
$2K |
| D2140 |
|
32 |
26 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$440.00 |