| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,546 |
1,535 |
$85K |
| D1120 |
Prophylaxis - child |
1,011 |
1,003 |
$38K |
| D1110 |
Prophylaxis - adult |
400 |
399 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
578 |
578 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
381 |
381 |
$24K |
| D0274 |
Bitewings - four radiographic images |
848 |
841 |
$18K |
| D9110 |
|
223 |
99 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
997 |
988 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
221 |
217 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
13 |
$2K |
| D9430 |
|
43 |
42 |
$1K |