| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,675 |
7,580 |
$184K |
| D1110 |
Prophylaxis - adult |
3,583 |
3,543 |
$153K |
| D1120 |
Prophylaxis - child |
4,239 |
4,190 |
$138K |
| D1206 |
Topical application of fluoride varnish |
5,653 |
5,592 |
$117K |
| D0274 |
Bitewings - four radiographic images |
2,337 |
2,318 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,353 |
1,339 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
449 |
264 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,617 |
1,600 |
$28K |
| D0330 |
Panoramic radiographic image |
470 |
466 |
$21K |
| D2140 |
|
301 |
211 |
$18K |
| D2160 |
|
116 |
62 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
110 |
108 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
40 |
$499.59 |