| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,072 |
1,072 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,100 |
1,100 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
462 |
462 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
501 |
501 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
338 |
337 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
421 |
421 |
$6K |
| D2160 |
|
52 |
30 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
27 |
$3K |
| D2332 |
|
21 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
37 |
37 |
$2K |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$588.00 |
| D0140 |
Limited oral evaluation - problem focused |
34 |
34 |
$478.80 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$385.28 |