| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
765 |
763 |
$25K |
| D1120 |
Prophylaxis - child |
742 |
732 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,179 |
854 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
198 |
198 |
$9K |
| D0274 |
Bitewings - four radiographic images |
435 |
432 |
$8K |
| D1206 |
Topical application of fluoride varnish |
736 |
726 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
88 |
38 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
101 |
100 |
$4K |
| D1351 |
Sealant - per tooth |
159 |
59 |
$3K |
| D2160 |
|
22 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
106 |
106 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$490.00 |
| D0220 |
Intraoral - periapical first radiographic image |
45 |
45 |
$410.00 |
| D0350 |
|
41 |
28 |
$337.20 |