| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,547 |
1,545 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
1,052 |
1,049 |
$25K |
| D0274 |
Bitewings - four radiographic images |
906 |
906 |
$24K |
| D9410 |
|
305 |
265 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
204 |
204 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
299 |
298 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
160 |
159 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
73 |
49 |
$961.00 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$104.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
30 |
$0.00 |