| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,840 |
4,830 |
$259K |
| D1120 |
Prophylaxis - child |
3,915 |
3,910 |
$144K |
| D1110 |
Prophylaxis - adult |
1,211 |
1,204 |
$98K |
| D0274 |
Bitewings - four radiographic images |
4,401 |
4,391 |
$89K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,195 |
826 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,217 |
5,205 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,241 |
4,969 |
$55K |
| D4910 |
|
709 |
701 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
554 |
554 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
652 |
651 |
$29K |
| D2140 |
|
342 |
240 |
$18K |
| D4341 |
|
93 |
26 |
$6K |
| D2160 |
|
15 |
12 |
$1K |
| D9430 |
|
13 |
13 |
$416.00 |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$288.00 |