| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,985 |
2,978 |
$146K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,161 |
3,159 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
2,687 |
2,678 |
$69K |
| D0330 |
Panoramic radiographic image |
1,829 |
1,823 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,539 |
2,535 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,441 |
1,439 |
$54K |
| D1320 |
|
1,972 |
1,964 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
831 |
826 |
$11K |
| D1120 |
Prophylaxis - child |
260 |
260 |
$11K |
| D9110 |
|
245 |
242 |
$6K |
| D1999 |
|
912 |
828 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
99 |
99 |
$1K |
| D1351 |
Sealant - per tooth |
35 |
12 |
$1K |
| D0602 |
|
13 |
13 |
$0.00 |
| D0603 |
|
19 |
19 |
$0.00 |
| D0601 |
|
16 |
16 |
$0.00 |