| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,144 |
1,136 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
1,321 |
1,311 |
$72K |
| D4910 |
|
678 |
664 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
534 |
534 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,962 |
1,953 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,906 |
1,653 |
$20K |
| D0274 |
Bitewings - four radiographic images |
780 |
775 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,304 |
1,214 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
270 |
270 |
$12K |
| D9430 |
|
269 |
256 |
$8K |
| D1120 |
Prophylaxis - child |
213 |
213 |
$7K |
| D4341 |
|
95 |
24 |
$7K |
| D0250 |
|
276 |
270 |
$6K |
| D1999 |
|
24 |
24 |
$0.00 |