| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,875 |
2,874 |
$155K |
| D1120 |
Prophylaxis - child |
2,417 |
2,416 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,555 |
3,448 |
$73K |
| D1110 |
Prophylaxis - adult |
707 |
707 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,290 |
2,289 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,977 |
1,976 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,111 |
1,031 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
232 |
232 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
131 |
131 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
30 |
14 |
$2K |
| D0350 |
|
76 |
69 |
$1K |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$468.00 |