| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
3,876 |
3,666 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
2,514 |
2,448 |
$93K |
| D9999 |
Unspecified adjunctive procedure, by report |
79 |
79 |
$38K |
| D1110 |
Prophylaxis - adult |
602 |
593 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
606 |
596 |
$32K |
| D1206 |
Topical application of fluoride varnish |
732 |
687 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
64 |
64 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
49 |
37 |
$2K |
| D0274 |
Bitewings - four radiographic images |
49 |
49 |
$833.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$624.00 |
| D0603 |
|
403 |
397 |
$606.00 |
| D0220 |
Intraoral - periapical first radiographic image |
61 |
61 |
$565.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
26 |
$160.00 |