| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,589 |
1,424 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,835 |
1,660 |
$34K |
| D0274 |
Bitewings - four radiographic images |
752 |
656 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,252 |
1,115 |
$19K |
| D0330 |
Panoramic radiographic image |
321 |
276 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
487 |
427 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
263 |
234 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
249 |
218 |
$6K |
| D1120 |
Prophylaxis - child |
265 |
236 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
183 |
164 |
$2K |
| D0272 |
Bitewings - two radiographic images |
28 |
25 |
$49.62 |
| D1999 |
|
28 |
21 |
$0.00 |