| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
487 |
465 |
$21K |
| D1110 |
Prophylaxis - adult |
475 |
458 |
$18K |
| D1120 |
Prophylaxis - child |
509 |
500 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
533 |
519 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
454 |
439 |
$8K |
| D0330 |
Panoramic radiographic image |
75 |
75 |
$4K |
| D1206 |
Topical application of fluoride varnish |
161 |
158 |
$3K |
| D0272 |
Bitewings - two radiographic images |
106 |
103 |
$2K |
| D9110 |
|
29 |
27 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
27 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
53 |
51 |
$796.20 |
| D0274 |
Bitewings - four radiographic images |
26 |
25 |
$775.06 |