| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
948 |
686 |
$49K |
| D1110 |
Prophylaxis - adult |
224 |
195 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
120 |
105 |
$10K |
| D9996 |
|
857 |
569 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
107 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
229 |
205 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
413 |
189 |
$4K |
| D0272 |
Bitewings - two radiographic images |
66 |
63 |
$2K |
| D0274 |
Bitewings - four radiographic images |
58 |
54 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
43 |
32 |
$985.60 |
| D0120 |
Periodic oral evaluation - established patient |
18 |
18 |
$878.40 |
| D1206 |
Topical application of fluoride varnish |
126 |
117 |
$0.00 |