| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
1,960 |
1,505 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
456 |
393 |
$22K |
| D1110 |
Prophylaxis - adult |
706 |
609 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
666 |
600 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
218 |
170 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
84 |
84 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
53 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
141 |
141 |
$1K |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$240.68 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$237.28 |