| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,014 |
903 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
831 |
797 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,104 |
959 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
914 |
770 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,972 |
1,733 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,712 |
1,513 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
437 |
387 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
226 |
187 |
$4K |
| D1120 |
Prophylaxis - child |
222 |
193 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
51 |
$4K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$509.52 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$280.00 |
| D0270 |
|
30 |
26 |
$122.00 |