| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,969 |
1,732 |
$77K |
| D1120 |
Prophylaxis - child |
1,620 |
1,460 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
3,127 |
2,767 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,155 |
1,006 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,446 |
1,300 |
$19K |
| D1206 |
Topical application of fluoride varnish |
754 |
694 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
321 |
309 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
589 |
560 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
145 |
138 |
$4K |
| D0272 |
Bitewings - two radiographic images |
147 |
143 |
$2K |
| D0330 |
Panoramic radiographic image |
60 |
56 |
$2K |
| D9110 |
|
25 |
25 |
$519.54 |
| D9986 |
|
402 |
345 |
$0.00 |
| D9987 |
|
13 |
12 |
$0.00 |