| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
560 |
544 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
641 |
624 |
$13K |
| D8670 |
Periodic orthodontic treatment visit |
127 |
115 |
$13K |
| D0274 |
Bitewings - four radiographic images |
294 |
286 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
179 |
176 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
497 |
462 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
274 |
227 |
$3K |
| D9110 |
|
85 |
83 |
$3K |
| D2954 |
|
21 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$767.38 |
| D1120 |
Prophylaxis - child |
25 |
25 |
$630.00 |
| D0272 |
Bitewings - two radiographic images |
29 |
22 |
$464.00 |