| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,586 |
1,534 |
$7K |
| D1110 |
Prophylaxis - adult |
944 |
905 |
$5K |
| D1120 |
Prophylaxis - child |
372 |
361 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,600 |
1,533 |
$4K |
| D0274 |
Bitewings - four radiographic images |
1,597 |
1,539 |
$3K |
| D1354 |
|
1,495 |
440 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
1,148 |
1,059 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
2,547 |
2,362 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,199 |
1,680 |
$1K |
| D0330 |
Panoramic radiographic image |
560 |
540 |
$845.00 |
| D0601 |
|
1,245 |
1,184 |
$756.00 |
| D1206 |
Topical application of fluoride varnish |
403 |
342 |
$403.81 |
| D0120 |
Periodic oral evaluation - established patient |
24 |
24 |
$312.06 |
| D1320 |
|
2,001 |
1,780 |
$147.00 |
| D1330 |
|
4,115 |
3,562 |
$61.00 |
| D1999 |
|
113 |
102 |
$21.00 |
| D0191 |
|
51 |
45 |
$0.00 |
| D2940 |
|
58 |
36 |
$0.00 |
| D1310 |
|
680 |
658 |
$0.00 |
| D0603 |
|
28 |
26 |
$0.00 |
| D9995 |
|
21 |
20 |
$0.00 |
| D4355 |
|
12 |
12 |
$0.00 |