| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,474 |
2,471 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,655 |
2,655 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,379 |
2,376 |
$67K |
| D0330 |
Panoramic radiographic image |
1,290 |
1,288 |
$43K |
| D0274 |
Bitewings - four radiographic images |
871 |
869 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,276 |
1,274 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,116 |
1,111 |
$18K |
| D1120 |
Prophylaxis - child |
251 |
251 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
570 |
570 |
$8K |
| D1206 |
Topical application of fluoride varnish |
89 |
89 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
75 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
95 |
$1K |
| D1999 |
|
18 |
18 |
$0.00 |