| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,624 |
2,615 |
$143K |
| D1110 |
Prophylaxis - adult |
1,324 |
1,316 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,742 |
3,181 |
$68K |
| D1120 |
Prophylaxis - child |
1,268 |
1,260 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
667 |
662 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,894 |
1,888 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,746 |
2,734 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
348 |
213 |
$23K |
| D0350 |
|
1,033 |
615 |
$11K |
| D1206 |
Topical application of fluoride varnish |
421 |
421 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
141 |
139 |
$6K |
| D2140 |
|
103 |
50 |
$6K |
| D4341 |
|
37 |
13 |
$3K |
| D4910 |
|
29 |
29 |
$2K |
| D9430 |
|
28 |
28 |
$896.00 |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
28 |
$319.00 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$316.00 |