| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
560 |
554 |
$35K |
| D1110 |
Prophylaxis - adult |
272 |
267 |
$23K |
| D1120 |
Prophylaxis - child |
449 |
445 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
315 |
312 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,214 |
773 |
$13K |
| D8670 |
Periodic orthodontic treatment visit |
41 |
41 |
$12K |
| D9430 |
|
360 |
328 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
255 |
253 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
783 |
775 |
$11K |
| D0274 |
Bitewings - four radiographic images |
547 |
539 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
126 |
81 |
$8K |
| D0350 |
|
94 |
50 |
$825.60 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$420.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$156.00 |