| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,207 |
949 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,481 |
1,334 |
$31K |
| D1120 |
Prophylaxis - child |
668 |
572 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,286 |
1,875 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
553 |
518 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
998 |
805 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,789 |
1,869 |
$15K |
| D1206 |
Topical application of fluoride varnish |
469 |
422 |
$14K |
| D1110 |
Prophylaxis - adult |
645 |
557 |
$11K |
| D1351 |
Sealant - per tooth |
541 |
64 |
$8K |
| D0272 |
Bitewings - two radiographic images |
206 |
146 |
$3K |
| D9110 |
|
49 |
47 |
$2K |
| D4355 |
|
53 |
16 |
$385.00 |
| D9310 |
|
43 |
27 |
$320.00 |
| D9212 |
|
116 |
26 |
$235.75 |