| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,746 |
1,746 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,154 |
2,152 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
2,520 |
2,507 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,522 |
1,521 |
$36K |
| D1120 |
Prophylaxis - child |
503 |
502 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,326 |
1,325 |
$16K |
| D0272 |
Bitewings - two radiographic images |
352 |
352 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
147 |
147 |
$3K |
| D1206 |
Topical application of fluoride varnish |
59 |
59 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
36 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
99 |
98 |
$1K |
| D1999 |
|
115 |
114 |
$0.00 |