| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,855 |
1,834 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
1,784 |
1,766 |
$33K |
| D0274 |
Bitewings - four radiographic images |
718 |
709 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,350 |
1,316 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
275 |
271 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
104 |
66 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
114 |
106 |
$5K |
| D1206 |
Topical application of fluoride varnish |
253 |
253 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
197 |
191 |
$3K |
| D2160 |
|
24 |
15 |
$2K |
| D0602 |
|
141 |
139 |
$690.00 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$670.86 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$570.86 |
| D0603 |
|
76 |
74 |
$365.00 |