| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,961 |
3,947 |
$252K |
| D0210 |
Intraoral - complete series of radiographic images |
3,895 |
3,882 |
$183K |
| D9430 |
|
639 |
553 |
$16K |
| D1110 |
Prophylaxis - adult |
153 |
152 |
$13K |
| D0250 |
|
430 |
430 |
$9K |
| D0350 |
|
975 |
255 |
$8K |
| D0260 |
|
1,497 |
473 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
119 |
119 |
$6K |
| D1120 |
Prophylaxis - child |
153 |
152 |
$5K |
| D1320 |
|
500 |
499 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,198 |
441 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
182 |
182 |
$2K |
| D4910 |
|
14 |
14 |
$1K |
| D0274 |
Bitewings - four radiographic images |
45 |
45 |
$842.40 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$132.00 |