| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,034 |
1,032 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,391 |
1,557 |
$37K |
| D1120 |
Prophylaxis - child |
747 |
744 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,294 |
1,288 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
222 |
222 |
$14K |
| D1110 |
Prophylaxis - adult |
178 |
176 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
699 |
697 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
91 |
42 |
$6K |
| D2140 |
|
46 |
26 |
$2K |
| D0274 |
Bitewings - four radiographic images |
40 |
40 |
$864.00 |
| D0350 |
|
24 |
12 |
$134.40 |