| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
952 |
948 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
655 |
653 |
$22K |
| D9430 |
|
569 |
454 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
296 |
293 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
987 |
409 |
$5K |
| D1206 |
Topical application of fluoride varnish |
181 |
180 |
$4K |
| D1110 |
Prophylaxis - adult |
42 |
42 |
$3K |
| D1120 |
Prophylaxis - child |
101 |
99 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
14 |
$2K |
| D0274 |
Bitewings - four radiographic images |
125 |
125 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
110 |
110 |
$697.00 |