| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
978 |
803 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,845 |
1,492 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,985 |
1,618 |
$40K |
| D1120 |
Prophylaxis - child |
1,061 |
860 |
$37K |
| D0330 |
Panoramic radiographic image |
385 |
314 |
$23K |
| D0274 |
Bitewings - four radiographic images |
344 |
272 |
$12K |
| D0272 |
Bitewings - two radiographic images |
267 |
210 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
91 |
82 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
54 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
45 |
42 |
$742.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
24 |
$297.00 |
| D1999 |
|
294 |
234 |
$0.00 |