| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,927 |
1,848 |
$56K |
| D1110 |
Prophylaxis - adult |
1,338 |
1,271 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,128 |
2,060 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,825 |
1,743 |
$40K |
| D1120 |
Prophylaxis - child |
402 |
392 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
339 |
302 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
153 |
149 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
407 |
279 |
$4K |
| D0191 |
|
82 |
73 |
$3K |
| D2954 |
|
18 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
28 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
18 |
$787.80 |