| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
2,855 |
2,800 |
$72K |
| D1120 |
Prophylaxis - child |
1,139 |
1,131 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,953 |
1,937 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,418 |
1,373 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,177 |
1,168 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,143 |
2,129 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
847 |
844 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
772 |
767 |
$17K |
| D1110 |
Prophylaxis - adult |
682 |
680 |
$14K |
| D1351 |
Sealant - per tooth |
327 |
63 |
$7K |
| D9110 |
|
79 |
77 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
45 |
45 |
$1K |
| D0602 |
|
269 |
267 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
56 |
56 |
$1K |
| D0601 |
|
135 |
135 |
$645.00 |
| D1999 |
|
12 |
12 |
$180.00 |