| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
956 |
954 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
1,629 |
1,620 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
961 |
959 |
$58K |
| D1120 |
Prophylaxis - child |
783 |
779 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
740 |
739 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
985 |
979 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,180 |
2,161 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,156 |
1,150 |
$17K |
| D9430 |
|
356 |
349 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,432 |
1,513 |
$9K |
| D1206 |
Topical application of fluoride varnish |
299 |
299 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$2K |
| D0270 |
|
24 |
24 |
$100.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$35.00 |
| D1330 |
|
688 |
685 |
$0.00 |