| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,229 |
1,213 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,565 |
1,491 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,172 |
1,156 |
$22K |
| D1120 |
Prophylaxis - child |
602 |
579 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
226 |
156 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
249 |
247 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
563 |
552 |
$6K |
| D4910 |
|
65 |
65 |
$5K |
| D1110 |
Prophylaxis - adult |
51 |
51 |
$4K |
| D2160 |
|
34 |
26 |
$2K |
| D0350 |
|
228 |
119 |
$2K |
| D0250 |
|
89 |
82 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
30 |
$1K |
| D1320 |
|
72 |
71 |
$1K |
| D1206 |
Topical application of fluoride varnish |
57 |
57 |
$581.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$144.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$120.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
12 |
12 |
$90.00 |