| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,340 |
1,334 |
$80K |
| D1110 |
Prophylaxis - adult |
872 |
870 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
773 |
772 |
$50K |
| D1120 |
Prophylaxis - child |
947 |
943 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,708 |
1,702 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,725 |
1,711 |
$24K |
| D2140 |
|
444 |
355 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
326 |
281 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,906 |
2,143 |
$20K |
| D9430 |
|
457 |
452 |
$14K |
| D0350 |
|
768 |
564 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
439 |
427 |
$5K |
| D0272 |
Bitewings - two radiographic images |
105 |
105 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$1K |