| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,359 |
2,185 |
$40K |
| D1110 |
Prophylaxis - adult |
1,169 |
1,093 |
$26K |
| D9410 |
|
516 |
447 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,476 |
1,339 |
$26K |
| D1120 |
Prophylaxis - child |
180 |
180 |
$8K |
| D5110 |
|
25 |
25 |
$8K |
| D1206 |
Topical application of fluoride varnish |
209 |
209 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
268 |
241 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
239 |
239 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
268 |
268 |
$1K |
| D0274 |
Bitewings - four radiographic images |
93 |
93 |
$1K |
| D0272 |
Bitewings - two radiographic images |
72 |
72 |
$720.00 |
| D0601 |
|
13 |
13 |
$130.00 |
| D0170 |
|
69 |
66 |
$0.00 |