| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
694 |
638 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,003 |
815 |
$22K |
| D9110 |
|
290 |
245 |
$15K |
| D1206 |
Topical application of fluoride varnish |
879 |
828 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
441 |
404 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,097 |
941 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
277 |
257 |
$7K |
| D0330 |
Panoramic radiographic image |
150 |
135 |
$6K |
| D0274 |
Bitewings - four radiographic images |
369 |
327 |
$5K |
| D1999 |
|
286 |
218 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
56 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
802 |
503 |
$1K |
| D1120 |
Prophylaxis - child |
40 |
37 |
$850.26 |
| D9630 |
|
27 |
25 |
$765.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
37 |
31 |
$382.62 |
| D0460 |
|
46 |
28 |
$19.40 |