| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,712 |
2,554 |
$62K |
| D1110 |
Prophylaxis - adult |
1,154 |
1,121 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,263 |
1,224 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,649 |
1,491 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,274 |
1,241 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,396 |
1,094 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
846 |
796 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
132 |
122 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
90 |
37 |
$6K |
| D1120 |
Prophylaxis - child |
126 |
125 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$468.80 |