| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,251 |
1,248 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,637 |
1,635 |
$32K |
| D2394 |
|
138 |
129 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,409 |
1,390 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
931 |
930 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
344 |
340 |
$6K |
| D0274 |
Bitewings - four radiographic images |
236 |
236 |
$5K |
| D0330 |
Panoramic radiographic image |
60 |
60 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
66 |
66 |
$1K |
| D0272 |
Bitewings - two radiographic images |
43 |
43 |
$584.80 |
| D1208 |
Topical application of fluoride, excluding varnish |
45 |
43 |
$457.80 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$118.32 |
| D1999 |
|
39 |
35 |
$0.00 |