| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,558 |
1,407 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,404 |
1,261 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
600 |
534 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,293 |
1,183 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,041 |
946 |
$21K |
| D0330 |
Panoramic radiographic image |
417 |
389 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
842 |
633 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,214 |
1,107 |
$19K |
| D1120 |
Prophylaxis - child |
750 |
690 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
454 |
347 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
364 |
348 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$136.50 |
| D1999 |
|
47 |
26 |
$0.00 |