| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,244 |
1,204 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
731 |
713 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,089 |
1,058 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
754 |
693 |
$15K |
| D0330 |
Panoramic radiographic image |
385 |
372 |
$12K |
| D0274 |
Bitewings - four radiographic images |
511 |
490 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
442 |
435 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
172 |
144 |
$5K |
| D1320 |
|
273 |
264 |
$4K |
| D1120 |
Prophylaxis - child |
205 |
202 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
791 |
736 |
$3K |
| D0272 |
Bitewings - two radiographic images |
201 |
196 |
$2K |
| D0270 |
|
13 |
13 |
$65.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
13 |
$60.00 |