| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,937 |
1,918 |
$78K |
| D1120 |
Prophylaxis - child |
1,344 |
1,337 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,394 |
1,387 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
293 |
293 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,514 |
1,870 |
$15K |
| D0274 |
Bitewings - four radiographic images |
1,139 |
1,133 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
353 |
351 |
$13K |
| D9999 |
Unspecified adjunctive procedure, by report |
93 |
93 |
$10K |
| D1110 |
Prophylaxis - adult |
119 |
119 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,568 |
1,496 |
$9K |
| D1999 |
|
678 |
595 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
15 |
15 |
$900.00 |
| D9430 |
|
29 |
29 |
$808.00 |
| D0330 |
Panoramic radiographic image |
49 |
49 |
$284.50 |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$149.00 |
| D0601 |
|
114 |
114 |
$1.00 |