| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
590 |
587 |
$38K |
| D2140 |
|
691 |
313 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
837 |
823 |
$29K |
| D9430 |
|
793 |
759 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
351 |
184 |
$23K |
| D1120 |
Prophylaxis - child |
604 |
597 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
399 |
387 |
$16K |
| D1110 |
Prophylaxis - adult |
227 |
220 |
$15K |
| D0274 |
Bitewings - four radiographic images |
704 |
697 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,536 |
1,486 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
570 |
560 |
$7K |
| D4341 |
|
56 |
15 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
168 |
167 |
$1K |