| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,298 |
3,106 |
$76K |
| D1120 |
Prophylaxis - child |
1,585 |
1,501 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,072 |
2,885 |
$60K |
| D1110 |
Prophylaxis - adult |
1,838 |
1,719 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,240 |
1,156 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
355 |
342 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
727 |
683 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
281 |
262 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
25 |
14 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
46 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
161 |
125 |
$2K |
| D2161 |
|
17 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$381.44 |