| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
826 |
816 |
$14K |
| D1110 |
Prophylaxis - adult |
380 |
361 |
$12K |
| D1120 |
Prophylaxis - child |
852 |
848 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
337 |
317 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,114 |
1,102 |
$5K |
| D0272 |
Bitewings - two radiographic images |
866 |
852 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
617 |
370 |
$2K |
| D9110 |
|
44 |
41 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
37 |
$768.00 |
| D0220 |
Intraoral - periapical first radiographic image |
175 |
154 |
$768.00 |
| D1330 |
|
511 |
456 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$0.00 |
| D1999 |
|
87 |
76 |
$0.00 |