| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,174 |
4,063 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,720 |
3,050 |
$67K |
| D1999 |
|
4,244 |
3,990 |
$61K |
| D0272 |
Bitewings - two radiographic images |
3,247 |
3,179 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
2,870 |
2,810 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,764 |
1,716 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,101 |
3,035 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
926 |
920 |
$13K |
| D2140 |
|
315 |
149 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
484 |
467 |
$8K |
| D2940 |
|
185 |
79 |
$5K |
| D1120 |
Prophylaxis - child |
161 |
161 |
$3K |