| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,234 |
2,226 |
$120K |
| D1110 |
Prophylaxis - adult |
1,177 |
1,168 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,470 |
3,957 |
$86K |
| D1206 |
Topical application of fluoride varnish |
3,460 |
3,446 |
$50K |
| D4910 |
|
442 |
441 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
458 |
454 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,249 |
1,239 |
$26K |
| D1120 |
Prophylaxis - child |
494 |
492 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,138 |
1,072 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
143 |
142 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
43 |
28 |
$3K |
| D4341 |
|
51 |
14 |
$3K |
| D9430 |
|
13 |
13 |
$416.00 |
| D0350 |
|
51 |
24 |
$375.60 |