| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,449 |
1,428 |
$65K |
| D1110 |
Prophylaxis - adult |
1,027 |
1,018 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,095 |
1,090 |
$37K |
| D9430 |
|
2,178 |
2,109 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
1,171 |
1,154 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
843 |
842 |
$14K |
| D4341 |
|
246 |
89 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,627 |
1,533 |
$12K |
| D0274 |
Bitewings - four radiographic images |
1,043 |
1,038 |
$10K |
| D1120 |
Prophylaxis - child |
235 |
234 |
$8K |
| D9999 |
Unspecified adjunctive procedure, by report |
66 |
64 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,457 |
1,374 |
$7K |
| D4910 |
|
25 |
25 |
$1K |
| D1999 |
|
353 |
336 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$46.20 |
| D1330 |
|
977 |
910 |
$0.00 |