| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,329 |
1,238 |
$37K |
| D1999 |
|
2,299 |
2,025 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,390 |
1,072 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
872 |
818 |
$20K |
| D0272 |
Bitewings - two radiographic images |
999 |
937 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
594 |
552 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
900 |
842 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
236 |
224 |
$3K |
| D0330 |
Panoramic radiographic image |
116 |
115 |
$3K |
| D1120 |
Prophylaxis - child |
51 |
47 |
$1K |
| D2140 |
|
17 |
13 |
$674.39 |