| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,089 |
1,045 |
$24K |
| D1110 |
Prophylaxis - adult |
559 |
539 |
$21K |
| D0274 |
Bitewings - four radiographic images |
659 |
631 |
$15K |
| D0330 |
Panoramic radiographic image |
360 |
346 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
657 |
628 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,030 |
961 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,307 |
758 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
242 |
220 |
$7K |
| D1120 |
Prophylaxis - child |
163 |
157 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
12 |
$618.50 |