| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,358 |
1,132 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,239 |
987 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,790 |
1,524 |
$27K |
| D0274 |
Bitewings - four radiographic images |
909 |
739 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,110 |
915 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
288 |
221 |
$7K |
| D1120 |
Prophylaxis - child |
445 |
355 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
755 |
558 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
202 |
142 |
$5K |
| D1351 |
Sealant - per tooth |
79 |
13 |
$2K |
| D4346 |
|
12 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
56 |
52 |
$875.79 |
| D0230 |
Intraoral - periapical each additional radiographic image |
137 |
79 |
$511.80 |
| D0330 |
Panoramic radiographic image |
61 |
43 |
$406.48 |
| D9420 |
|
12 |
12 |
$0.00 |