| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,286 |
4,092 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
5,499 |
5,274 |
$96K |
| D0274 |
Bitewings - four radiographic images |
1,593 |
1,528 |
$31K |
| D1120 |
Prophylaxis - child |
1,577 |
1,521 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,762 |
1,705 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,291 |
2,189 |
$12K |
| D0272 |
Bitewings - two radiographic images |
934 |
907 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,262 |
1,199 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
293 |
277 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
32 |
$790.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
123 |
89 |
$630.00 |
| D1999 |
|
81 |
77 |
$0.00 |