| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
521 |
514 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
440 |
435 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
263 |
256 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
837 |
784 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
51 |
51 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
155 |
154 |
$5K |
| D1120 |
Prophylaxis - child |
102 |
99 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
48 |
27 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
629 |
523 |
$2K |
| D1206 |
Topical application of fluoride varnish |
104 |
104 |
$2K |
| D9430 |
|
54 |
52 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
94 |
91 |
$1K |
| D0274 |
Bitewings - four radiographic images |
67 |
67 |
$972.00 |
| D0140 |
Limited oral evaluation - problem focused |
63 |
61 |
$945.00 |
| D1330 |
|
255 |
239 |
$0.00 |