| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,035 |
1,985 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
1,151 |
1,124 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,453 |
1,426 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,069 |
1,041 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,413 |
1,377 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,231 |
1,028 |
$4K |
| D9310 |
|
128 |
124 |
$2K |
| D0272 |
Bitewings - two radiographic images |
440 |
428 |
$2K |
| D1120 |
Prophylaxis - child |
93 |
92 |
$2K |
| D0274 |
Bitewings - four radiographic images |
28 |
28 |
$373.55 |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
42 |
$346.50 |