| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,610 |
1,598 |
$150K |
| D1120 |
Prophylaxis - child |
1,564 |
1,549 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,089 |
1,079 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
80 |
52 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$3K |
| D1206 |
Topical application of fluoride varnish |
1,461 |
1,447 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
965 |
949 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
812 |
801 |
$744.25 |
| D0274 |
Bitewings - four radiographic images |
226 |
225 |
$708.59 |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
107 |
$0.00 |
| D0330 |
Panoramic radiographic image |
30 |
30 |
$0.00 |