| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,871 |
1,819 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,160 |
2,101 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,266 |
2,224 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,525 |
2,468 |
$51K |
| D1120 |
Prophylaxis - child |
881 |
869 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,457 |
1,100 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
448 |
428 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
414 |
394 |
$12K |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$852.60 |
| D0220 |
Intraoral - periapical first radiographic image |
83 |
80 |
$840.56 |
| D1999 |
|
32 |
29 |
$0.00 |