| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,248 |
1,222 |
$45K |
| D9110 |
|
945 |
933 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,955 |
1,922 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
3,020 |
2,437 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,191 |
1,171 |
$26K |
| D0330 |
Panoramic radiographic image |
394 |
363 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,085 |
1,063 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,142 |
1,675 |
$20K |
| D4341 |
|
298 |
85 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
632 |
545 |
$17K |
| D1120 |
Prophylaxis - child |
505 |
496 |
$16K |
| D4910 |
|
238 |
237 |
$5K |
| D7510 |
|
238 |
213 |
$4K |
| D9920 |
|
14 |
13 |
$1K |