| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
879 |
876 |
$30K |
| D1110 |
Prophylaxis - adult |
455 |
453 |
$20K |
| D1120 |
Prophylaxis - child |
610 |
609 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
946 |
943 |
$16K |
| D0274 |
Bitewings - four radiographic images |
499 |
494 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
70 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
50 |
30 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
112 |
112 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
54 |
$2K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$510.90 |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
38 |
$420.46 |