| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,315 |
2,283 |
$36K |
| D1110 |
Prophylaxis - adult |
1,629 |
1,605 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,329 |
1,303 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
2,142 |
2,101 |
$8K |
| D1120 |
Prophylaxis - child |
550 |
547 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
526 |
524 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,886 |
1,851 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
219 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
154 |
151 |
$4K |
| D0272 |
Bitewings - two radiographic images |
208 |
208 |
$1K |
| D0601 |
|
14 |
13 |
$30.00 |
| D1999 |
|
45 |
44 |
$0.00 |
| D1330 |
|
29 |
29 |
$0.00 |