| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,747 |
1,731 |
$98K |
| D1110 |
Prophylaxis - adult |
878 |
872 |
$76K |
| D1120 |
Prophylaxis - child |
1,072 |
1,065 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
640 |
639 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,341 |
2,326 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
328 |
327 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,934 |
1,133 |
$14K |
| D0272 |
Bitewings - two radiographic images |
565 |
558 |
$7K |
| D9430 |
|
183 |
157 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
451 |
420 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
50 |
32 |
$3K |
| D2160 |
|
19 |
13 |
$2K |