| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
744 |
730 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
370 |
366 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,233 |
1,210 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
591 |
581 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
85 |
53 |
$8K |
| D1120 |
Prophylaxis - child |
474 |
470 |
$6K |
| D1110 |
Prophylaxis - adult |
254 |
249 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
73 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
114 |
108 |
$3K |
| D1206 |
Topical application of fluoride varnish |
548 |
544 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$806.61 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,211 |
996 |
$600.44 |
| D0270 |
|
16 |
15 |
$217.48 |