| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
406 |
379 |
$9K |
| D0272 |
Bitewings - two radiographic images |
233 |
224 |
$3K |
| D1999 |
|
241 |
203 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
262 |
253 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
171 |
164 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
157 |
150 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
374 |
126 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
145 |
137 |
$755.50 |
| D1120 |
Prophylaxis - child |
31 |
31 |
$502.20 |
| D2140 |
|
21 |
15 |
$450.60 |
| D2160 |
|
14 |
13 |
$416.40 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$128.00 |