| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,071 |
1,056 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,350 |
1,327 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
794 |
773 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,489 |
1,468 |
$16K |
| D9999 |
Unspecified adjunctive procedure, by report |
58 |
56 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
541 |
521 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,645 |
1,516 |
$4K |
| D9430 |
|
183 |
155 |
$3K |
| D1120 |
Prophylaxis - child |
247 |
241 |
$2K |
| D0274 |
Bitewings - four radiographic images |
422 |
416 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,087 |
1,061 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
136 |
127 |
$130.90 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$11.00 |
| D9110 |
|
22 |
20 |
$0.00 |
| D1330 |
|
675 |
648 |
$0.00 |