| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,081 |
1,073 |
$59K |
| D1120 |
Prophylaxis - child |
985 |
973 |
$44K |
| D0330 |
Panoramic radiographic image |
305 |
302 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
2,050 |
2,025 |
$27K |
| D1330 |
|
2,092 |
2,072 |
$6K |
| D1206 |
Topical application of fluoride varnish |
2,038 |
2,020 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$3K |
| D1351 |
Sealant - per tooth |
1,253 |
358 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,419 |
1,404 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,768 |
1,125 |
$780.40 |
| D0220 |
Intraoral - periapical first radiographic image |
1,209 |
1,190 |
$567.82 |
| D0601 |
|
174 |
170 |
$542.80 |
| D0603 |
|
39 |
38 |
$482.31 |
| D0602 |
|
56 |
54 |
$297.16 |
| D0272 |
Bitewings - two radiographic images |
278 |
274 |
$252.28 |
| D1999 |
|
71 |
70 |
$0.00 |