| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,217 |
3,216 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
2,968 |
2,966 |
$48K |
| D0274 |
Bitewings - four radiographic images |
3,053 |
3,053 |
$43K |
| D1120 |
Prophylaxis - child |
1,139 |
1,138 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,942 |
3,909 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,646 |
1,645 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,821 |
2,803 |
$21K |
| D0330 |
Panoramic radiographic image |
413 |
412 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,090 |
1,089 |
$9K |
| D0272 |
Bitewings - two radiographic images |
263 |
263 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
162 |
158 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
253 |
253 |
$1K |
| D1999 |
|
94 |
92 |
$0.00 |