| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,315 |
1,248 |
$60K |
| D0330 |
Panoramic radiographic image |
1,133 |
1,094 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,986 |
1,909 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,613 |
1,528 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,578 |
1,482 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,584 |
1,497 |
$20K |
| D1120 |
Prophylaxis - child |
420 |
389 |
$13K |
| D4346 |
|
136 |
136 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
210 |
204 |
$6K |
| D0272 |
Bitewings - two radiographic images |
64 |
54 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
94 |
94 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
49 |
$393.45 |