| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9110 |
|
466 |
423 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
610 |
608 |
$25K |
| D1110 |
Prophylaxis - adult |
290 |
289 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,500 |
1,335 |
$17K |
| D0274 |
Bitewings - four radiographic images |
507 |
507 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
122 |
122 |
$6K |
| D9430 |
|
185 |
177 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
440 |
439 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
748 |
449 |
$3K |
| D1120 |
Prophylaxis - child |
100 |
99 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$624.00 |
| D1206 |
Topical application of fluoride varnish |
29 |
29 |
$252.00 |