| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,101 |
1,052 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,294 |
1,239 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,078 |
1,055 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,097 |
1,048 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
347 |
322 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
112 |
52 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
530 |
467 |
$6K |
| D2140 |
|
41 |
24 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
50 |
$831.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
140 |
134 |
$795.15 |
| D0999 |
Unspecified diagnostic procedure, by report |
13 |
13 |
$390.00 |
| D1999 |
|
156 |
133 |
$180.00 |