| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
2,482 |
2,225 |
$56K |
| D1110 |
Prophylaxis - adult |
720 |
714 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,084 |
1,068 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
428 |
419 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
680 |
672 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,485 |
847 |
$9K |
| D1120 |
Prophylaxis - child |
157 |
155 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
545 |
534 |
$4K |
| D0274 |
Bitewings - four radiographic images |
201 |
201 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
47 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$2K |
| D1999 |
|
63 |
62 |
$230.50 |
| D0270 |
|
15 |
15 |
$61.00 |
| D1330 |
|
47 |
47 |
$0.00 |