| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0486 |
Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment |
181 |
174 |
$272K |
| D1110 |
Prophylaxis - adult |
1,988 |
1,975 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,133 |
3,118 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,105 |
1,098 |
$39K |
| D4341 |
|
636 |
211 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
870 |
852 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,137 |
1,111 |
$9K |
| D1120 |
Prophylaxis - child |
214 |
214 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
448 |
448 |
$5K |
| D0274 |
Bitewings - four radiographic images |
139 |
139 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13 |
13 |
$435.16 |
| D1999 |
|
44 |
34 |
$0.00 |