| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
598 |
565 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
205 |
196 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,095 |
1,040 |
$6K |
| D9211 |
|
72 |
66 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
29 |
14 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
93 |
$879.16 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$228.22 |
| D0230 |
Intraoral - periapical each additional radiographic image |
186 |
148 |
$150.72 |
| D1110 |
Prophylaxis - adult |
63 |
63 |
$49.67 |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$21.44 |