| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,625 |
1,590 |
$32K |
| D1110 |
Prophylaxis - adult |
835 |
813 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
502 |
491 |
$13K |
| D9999 |
Unspecified adjunctive procedure, by report |
101 |
96 |
$13K |
| D1120 |
Prophylaxis - child |
802 |
789 |
$11K |
| D1206 |
Topical application of fluoride varnish |
838 |
826 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,531 |
1,470 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
166 |
163 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,331 |
1,288 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
143 |
143 |
$3K |
| D0274 |
Bitewings - four radiographic images |
107 |
107 |
$1K |
| D1999 |
|
364 |
341 |
$560.00 |