| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,413 |
1,413 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
2,271 |
2,224 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
830 |
788 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
446 |
284 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,058 |
1,498 |
$24K |
| D2752 |
|
29 |
14 |
$16K |
| D1120 |
Prophylaxis - child |
390 |
390 |
$13K |
| D2140 |
|
226 |
126 |
$12K |
| D0274 |
Bitewings - four radiographic images |
237 |
237 |
$10K |
| D1110 |
Prophylaxis - adult |
212 |
212 |
$10K |
| D0272 |
Bitewings - two radiographic images |
310 |
310 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
442 |
436 |
$2K |
| D2160 |
|
18 |
14 |
$1K |