| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,391 |
4,381 |
$167K |
| D0330 |
Panoramic radiographic image |
2,957 |
2,954 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
3,114 |
3,105 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,332 |
2,330 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,801 |
1,797 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,996 |
2,994 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,779 |
2,764 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,139 |
2,049 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
287 |
287 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
126 |
$1K |
| D1120 |
Prophylaxis - child |
43 |
43 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
12 |
$1K |
| D1999 |
|
100 |
100 |
$0.00 |