| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
841 |
797 |
$21K |
| D1110 |
Prophylaxis - adult |
340 |
319 |
$15K |
| D1206 |
Topical application of fluoride varnish |
474 |
444 |
$9K |
| D0272 |
Bitewings - two radiographic images |
391 |
366 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
114 |
60 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
265 |
227 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
74 |
69 |
$6K |
| D1120 |
Prophylaxis - child |
177 |
169 |
$6K |
| D2140 |
|
46 |
27 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
161 |
142 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
27 |
$356.25 |
| D0602 |
|
20 |
18 |
$100.00 |