| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
617 |
612 |
$32K |
| D1110 |
Prophylaxis - adult |
202 |
200 |
$16K |
| D1206 |
Topical application of fluoride varnish |
518 |
516 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
598 |
574 |
$7K |
| D0274 |
Bitewings - four radiographic images |
277 |
275 |
$6K |
| D4910 |
|
42 |
40 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
101 |
93 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
57 |
$2K |
| D9430 |
|
67 |
57 |
$2K |
| D1999 |
|
200 |
186 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
437 |
416 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
12 |
$468.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$0.00 |