| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,772 |
2,687 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
2,908 |
2,818 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,368 |
1,324 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,164 |
1,079 |
$40K |
| D0330 |
Panoramic radiographic image |
658 |
626 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,708 |
1,583 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,447 |
1,404 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
493 |
463 |
$20K |
| D1120 |
Prophylaxis - child |
482 |
459 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
84 |
66 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
392 |
266 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
61 |
53 |
$3K |
| D2140 |
|
17 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
56 |
55 |
$973.85 |