| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,418 |
2,418 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
2,165 |
2,163 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,969 |
1,969 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,477 |
2,470 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
672 |
669 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,420 |
2,409 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
726 |
726 |
$16K |
| D1120 |
Prophylaxis - child |
345 |
345 |
$11K |
| D2394 |
|
88 |
70 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
537 |
537 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
291 |
278 |
$4K |
| D1999 |
|
13 |
13 |
$0.00 |