| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
840 |
836 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,181 |
1,430 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,086 |
1,081 |
$13K |
| D1120 |
Prophylaxis - child |
237 |
236 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
132 |
132 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
41 |
26 |
$3K |
| D9430 |
|
16 |
16 |
$512.00 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$510.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$209.50 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
14 |
$201.00 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$168.00 |