| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
167 |
134 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
286 |
272 |
$10K |
| D1120 |
Prophylaxis - child |
298 |
273 |
$9K |
| D1206 |
Topical application of fluoride varnish |
218 |
215 |
$211.91 |
| D0274 |
Bitewings - four radiographic images |
63 |
62 |
$72.02 |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$34.72 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
113 |
112 |
$26.45 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$0.25 |
| D0220 |
Intraoral - periapical first radiographic image |
58 |
56 |
$0.12 |
| D0140 |
Limited oral evaluation - problem focused |
50 |
50 |
$0.09 |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$0.08 |