| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,308 |
1,308 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,267 |
1,267 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,191 |
1,191 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,351 |
1,348 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,250 |
1,249 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
386 |
386 |
$7K |
| D9945 |
|
42 |
42 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
128 |
128 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
246 |
246 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$394.40 |