| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,220 |
1,217 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,622 |
1,619 |
$8K |
| D1110 |
Prophylaxis - adult |
1,027 |
1,023 |
$5K |
| D0274 |
Bitewings - four radiographic images |
995 |
992 |
$5K |
| D1120 |
Prophylaxis - child |
476 |
475 |
$5K |
| D0330 |
Panoramic radiographic image |
1,141 |
1,138 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
661 |
659 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,065 |
1,057 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
873 |
837 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
61 |
$794.00 |
| D4341 |
|
25 |
12 |
$0.00 |