| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
431 |
429 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
253 |
250 |
$4K |
| D1206 |
Topical application of fluoride varnish |
174 |
172 |
$3K |
| D0274 |
Bitewings - four radiographic images |
108 |
107 |
$2K |
| D1110 |
Prophylaxis - adult |
57 |
55 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
42 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
68 |
66 |
$708.50 |
| D1999 |
|
61 |
49 |
$427.00 |
| D0603 |
|
12 |
12 |
$44.00 |