| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,564 |
1,329 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
963 |
777 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
982 |
913 |
$29K |
| D1110 |
Prophylaxis - adult |
459 |
406 |
$28K |
| D0350 |
|
2,492 |
1,035 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,155 |
1,781 |
$16K |
| D0274 |
Bitewings - four radiographic images |
816 |
775 |
$10K |
| D9430 |
|
1,575 |
1,265 |
$8K |
| D0330 |
Panoramic radiographic image |
778 |
707 |
$6K |
| D1120 |
Prophylaxis - child |
86 |
85 |
$4K |
| D9995 |
|
139 |
115 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
623 |
440 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
56 |
56 |
$968.00 |
| D4910 |
|
12 |
12 |
$612.00 |
| D0272 |
Bitewings - two radiographic images |
56 |
50 |
$370.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$226.00 |
| D0270 |
|
43 |
43 |
$190.00 |
| D1999 |
|
41 |
39 |
$60.00 |
| D9996 |
|
100 |
76 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
19 |
16 |
$0.00 |