| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
1,314 |
1,064 |
$42K |
| D4910 |
|
500 |
499 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
388 |
385 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
186 |
186 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
303 |
301 |
$14K |
| D1110 |
Prophylaxis - adult |
134 |
134 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
551 |
551 |
$8K |
| D1320 |
|
308 |
305 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,160 |
330 |
$5K |
| D1120 |
Prophylaxis - child |
67 |
67 |
$4K |
| D0274 |
Bitewings - four radiographic images |
119 |
119 |
$2K |
| D1206 |
Topical application of fluoride varnish |
69 |
69 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
73 |
73 |
$876.00 |
| D0250 |
|
14 |
14 |
$308.00 |