| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,753 |
2,438 |
$85K |
| D2752 |
|
379 |
141 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,610 |
2,264 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
804 |
703 |
$31K |
| D2950 |
|
573 |
225 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
2,021 |
1,778 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,086 |
943 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,164 |
1,009 |
$20K |
| D2161 |
|
329 |
127 |
$20K |
| D2791 |
|
141 |
44 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
791 |
691 |
$6K |
| D1206 |
Topical application of fluoride varnish |
415 |
394 |
$6K |
| D4341 |
|
65 |
15 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
121 |
102 |
$2K |
| D0330 |
Panoramic radiographic image |
149 |
105 |
$1K |
| D1120 |
Prophylaxis - child |
57 |
55 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
12 |
$89.98 |