| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,896 |
4,886 |
$84K |
| D1110 |
Prophylaxis - adult |
2,647 |
2,643 |
$82K |
| D0274 |
Bitewings - four radiographic images |
1,542 |
1,539 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,627 |
2,610 |
$23K |
| D1120 |
Prophylaxis - child |
846 |
845 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,424 |
1,424 |
$13K |
| D0272 |
Bitewings - two radiographic images |
923 |
921 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
714 |
713 |
$6K |
| D0330 |
Panoramic radiographic image |
212 |
212 |
$3K |
| D1999 |
|
28 |
28 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
29 |
$216.32 |
| D0601 |
|
15 |
15 |
$15.00 |