| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4346 |
|
231 |
215 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,624 |
1,573 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,592 |
1,548 |
$36K |
| D1110 |
Prophylaxis - adult |
662 |
653 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,891 |
982 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
682 |
656 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,319 |
1,265 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
791 |
773 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
1,066 |
565 |
$8K |
| D4342 |
|
52 |
13 |
$8K |
| D1120 |
Prophylaxis - child |
108 |
107 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
19 |
$1K |