| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
261 |
255 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
186 |
100 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
176 |
173 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
270 |
260 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,850 |
367 |
$6K |
| D1120 |
Prophylaxis - child |
131 |
128 |
$3K |
| D0274 |
Bitewings - four radiographic images |
154 |
146 |
$2K |
| D2160 |
|
20 |
12 |
$1K |
| D2140 |
|
30 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
78 |
76 |
$548.80 |
| D0220 |
Intraoral - periapical first radiographic image |
84 |
64 |
$425.00 |