| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,882 |
1,502 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
451 |
425 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,822 |
1,019 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
160 |
142 |
$15K |
| D0274 |
Bitewings - four radiographic images |
361 |
342 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
80 |
73 |
$5K |
| D1206 |
Topical application of fluoride varnish |
237 |
232 |
$4K |
| D1110 |
Prophylaxis - adult |
213 |
188 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
54 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
57 |
$2K |
| D1120 |
Prophylaxis - child |
113 |
112 |
$1K |