| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,516 |
1,361 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,025 |
1,808 |
$34K |
| D0274 |
Bitewings - four radiographic images |
849 |
733 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,091 |
938 |
$15K |
| D1120 |
Prophylaxis - child |
439 |
387 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
146 |
125 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
63 |
$2K |
| D0330 |
Panoramic radiographic image |
87 |
70 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
68 |
55 |
$767.34 |
| D2140 |
|
40 |
27 |
$239.60 |
| D0272 |
Bitewings - two radiographic images |
17 |
15 |
$99.24 |
| D1999 |
|
653 |
510 |
$45.00 |