| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
554 |
497 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
879 |
769 |
$22K |
| D1206 |
Topical application of fluoride varnish |
747 |
654 |
$14K |
| D0272 |
Bitewings - two radiographic images |
627 |
566 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
894 |
745 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
731 |
532 |
$9K |
| D1120 |
Prophylaxis - child |
105 |
87 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$2K |
| D0330 |
Panoramic radiographic image |
16 |
14 |
$920.50 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$444.60 |
| D0602 |
|
95 |
93 |
$410.00 |