| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,165 |
1,975 |
$69K |
| D0330 |
Panoramic radiographic image |
1,286 |
1,118 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
2,249 |
2,087 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,985 |
1,808 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,130 |
985 |
$24K |
| D1120 |
Prophylaxis - child |
840 |
808 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
918 |
865 |
$12K |
| D0272 |
Bitewings - two radiographic images |
469 |
450 |
$6K |
| D1999 |
|
79 |
73 |
$390.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
250 |
195 |
$0.00 |