| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2991 |
|
5,596 |
572 |
$622K |
| D0330 |
Panoramic radiographic image |
551 |
547 |
$47K |
| D1110 |
Prophylaxis - adult |
526 |
462 |
$32K |
| D0274 |
Bitewings - four radiographic images |
589 |
586 |
$26K |
| D1330 |
|
683 |
586 |
$22K |
| D1206 |
Topical application of fluoride varnish |
617 |
600 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
461 |
445 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
352 |
351 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,196 |
708 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
779 |
773 |
$15K |
| D0350 |
|
642 |
571 |
$10K |
| D1351 |
Sealant - per tooth |
195 |
44 |
$8K |
| D1120 |
Prophylaxis - child |
121 |
88 |
$4K |
| D1354 |
|
100 |
46 |
$4K |
| D4355 |
|
43 |
31 |
$2K |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$2K |
| D0240 |
|
24 |
12 |
$1K |
| D1310 |
|
29 |
29 |
$828.44 |
| D9110 |
|
12 |
12 |
$646.05 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$558.58 |
| D9996 |
|
96 |
96 |
$0.00 |