| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,472 |
6,471 |
$254K |
| D0120 |
Periodic oral evaluation - established patient |
8,863 |
8,862 |
$179K |
| D0274 |
Bitewings - four radiographic images |
3,840 |
3,840 |
$77K |
| D1120 |
Prophylaxis - child |
1,615 |
1,615 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,806 |
3,805 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,448 |
3,446 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,241 |
2,238 |
$22K |
| D0272 |
Bitewings - two radiographic images |
411 |
411 |
$5K |
| D9110 |
|
224 |
224 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
45 |
$917.10 |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$743.06 |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$493.29 |
| D1999 |
|
236 |
227 |
$0.00 |