| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
4,594 |
3,172 |
$65K |
| D1110 |
Prophylaxis - adult |
1,469 |
1,036 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,862 |
1,254 |
$29K |
| D1120 |
Prophylaxis - child |
1,417 |
949 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,785 |
1,209 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,133 |
817 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
661 |
524 |
$15K |
| D0330 |
Panoramic radiographic image |
343 |
301 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
686 |
432 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
390 |
260 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
23 |
12 |
$480.58 |
| D1330 |
|
15 |
14 |
$75.00 |