| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
940 |
926 |
$32K |
| D1110 |
Prophylaxis - adult |
1,287 |
1,264 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
945 |
930 |
$27K |
| D1330 |
|
2,005 |
1,972 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
804 |
790 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,566 |
1,536 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
640 |
624 |
$646.29 |
| D0274 |
Bitewings - four radiographic images |
309 |
304 |
$578.66 |
| D0140 |
Limited oral evaluation - problem focused |
53 |
49 |
$462.83 |
| D0230 |
Intraoral - periapical each additional radiographic image |
392 |
386 |
$336.74 |