| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,266 |
1,214 |
$64K |
| D0274 |
Bitewings - four radiographic images |
846 |
807 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,201 |
1,144 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,248 |
1,175 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
377 |
364 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
973 |
894 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
303 |
280 |
$8K |
| D0330 |
Panoramic radiographic image |
73 |
72 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
41 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
65 |
$3K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$660.00 |