| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
985 |
939 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
947 |
898 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
913 |
768 |
$12K |
| D2394 |
|
79 |
26 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
182 |
172 |
$6K |
| D1206 |
Topical application of fluoride varnish |
234 |
225 |
$6K |
| D0274 |
Bitewings - four radiographic images |
151 |
142 |
$5K |
| D1120 |
Prophylaxis - child |
109 |
106 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
133 |
$5K |
| D9110 |
|
121 |
96 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
66 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
337 |
252 |
$3K |
| D0431 |
|
14 |
12 |
$0.00 |