| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,702 |
2,676 |
$25K |
| D1110 |
Prophylaxis - adult |
1,257 |
1,248 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
656 |
656 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,934 |
1,901 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,947 |
1,458 |
$3K |
| D2740 |
Crown - porcelain/ceramic |
33 |
29 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
232 |
230 |
$2K |
| D0274 |
Bitewings - four radiographic images |
136 |
134 |
$635.00 |
| D2954 |
|
16 |
14 |
$405.00 |
| D1120 |
Prophylaxis - child |
37 |
37 |
$294.00 |
| D0272 |
Bitewings - two radiographic images |
247 |
245 |
$185.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
39 |
39 |
$180.00 |
| D0270 |
|
24 |
24 |
$72.00 |
| D1999 |
|
15 |
15 |
$0.00 |