| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,649 |
1,649 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
1,251 |
1,250 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
536 |
534 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,178 |
1,168 |
$14K |
| D0274 |
Bitewings - four radiographic images |
292 |
292 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
299 |
299 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
474 |
474 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
213 |
209 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
12 |
$1K |