| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
335 |
310 |
$16K |
| D0274 |
Bitewings - four radiographic images |
227 |
218 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
311 |
306 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
62 |
43 |
$5K |
| D2140 |
|
69 |
49 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
61 |
52 |
$2K |
| D1120 |
Prophylaxis - child |
277 |
268 |
$480.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
254 |
224 |
$452.94 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
14 |
$141.77 |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$92.36 |
| D1206 |
Topical application of fluoride varnish |
304 |
295 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
26 |
$0.00 |