| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,523 |
2,613 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
3,199 |
2,348 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,271 |
986 |
$14K |
| D1206 |
Topical application of fluoride varnish |
1,148 |
824 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,226 |
914 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
53 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
113 |
103 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
191 |
171 |
$1K |
| D0330 |
Panoramic radiographic image |
82 |
74 |
$479.85 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$324.36 |
| D1999 |
|
341 |
217 |
$0.00 |