| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
478 |
475 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
348 |
345 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
586 |
557 |
$20K |
| D0274 |
Bitewings - four radiographic images |
528 |
524 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
389 |
369 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
150 |
103 |
$12K |
| D1120 |
Prophylaxis - child |
363 |
361 |
$3K |
| D1110 |
Prophylaxis - adult |
122 |
121 |
$2K |
| D0330 |
Panoramic radiographic image |
72 |
72 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
14 |
$2K |
| D1206 |
Topical application of fluoride varnish |
420 |
419 |
$517.12 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$211.01 |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
26 |
$46.57 |