| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,977 |
1,957 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,496 |
2,477 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,466 |
1,196 |
$53K |
| D0160 |
|
600 |
465 |
$41K |
| D9110 |
|
614 |
528 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,471 |
1,411 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
931 |
924 |
$15K |
| D1120 |
Prophylaxis - child |
494 |
489 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,087 |
970 |
$13K |
| D0274 |
Bitewings - four radiographic images |
280 |
277 |
$9K |
| D1206 |
Topical application of fluoride varnish |
473 |
470 |
$8K |
| D2140 |
|
87 |
53 |
$7K |
| D0330 |
Panoramic radiographic image |
58 |
56 |
$3K |
| D0272 |
Bitewings - two radiographic images |
58 |
58 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$638.10 |
| D1330 |
|
52 |
48 |
$0.00 |