| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,634 |
1,620 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,637 |
1,624 |
$45K |
| D1110 |
Prophylaxis - adult |
754 |
748 |
$40K |
| D0274 |
Bitewings - four radiographic images |
724 |
716 |
$28K |
| D1120 |
Prophylaxis - child |
712 |
712 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,118 |
1,092 |
$18K |
| D9920 |
|
307 |
287 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
969 |
875 |
$12K |
| D1330 |
|
440 |
440 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
86 |
86 |
$3K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$2K |
| D0272 |
Bitewings - two radiographic images |
22 |
22 |
$532.95 |