| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
616 |
616 |
$40K |
| D1120 |
Prophylaxis - child |
444 |
444 |
$23K |
| D1110 |
Prophylaxis - adult |
230 |
230 |
$20K |
| D0274 |
Bitewings - four radiographic images |
442 |
442 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
163 |
163 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
428 |
428 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
73 |
62 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
74 |
74 |
$3K |
| D9430 |
|
101 |
100 |
$3K |
| D2140 |
|
42 |
32 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
116 |
116 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
318 |
190 |
$1K |