| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
10,205 |
2,648 |
$90K |
| D1110 |
Prophylaxis - adult |
851 |
826 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
922 |
903 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
838 |
825 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
701 |
691 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,362 |
1,473 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,776 |
1,741 |
$22K |
| D1120 |
Prophylaxis - child |
479 |
470 |
$17K |
| D9430 |
|
214 |
212 |
$7K |
| D0274 |
Bitewings - four radiographic images |
297 |
292 |
$6K |
| D1206 |
Topical application of fluoride varnish |
84 |
76 |
$412.00 |
| D0272 |
Bitewings - two radiographic images |
30 |
26 |
$210.00 |