| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,276 |
2,163 |
$36K |
| D1120 |
Prophylaxis - child |
1,646 |
1,579 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,621 |
1,551 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
3,032 |
2,739 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
407 |
403 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,889 |
2,086 |
$5K |
| D9110 |
|
263 |
219 |
$3K |
| D0274 |
Bitewings - four radiographic images |
345 |
337 |
$3K |
| D0272 |
Bitewings - two radiographic images |
666 |
638 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
110 |
$2K |
| D9430 |
|
138 |
132 |
$2K |
| D1110 |
Prophylaxis - adult |
38 |
37 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
147 |
146 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
14 |
14 |
$840.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$520.00 |
| D1330 |
|
1,025 |
984 |
$0.00 |
| D0601 |
|
42 |
25 |
$0.00 |
| D1310 |
|
72 |
49 |
$0.00 |
| D9993 |
|
41 |
25 |
$0.00 |
| D0707 |
|
46 |
42 |
$0.00 |