| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,357 |
1,330 |
$38K |
| D1120 |
Prophylaxis - child |
899 |
887 |
$37K |
| D9110 |
|
237 |
234 |
$12K |
| D0274 |
Bitewings - four radiographic images |
611 |
607 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
608 |
600 |
$11K |
| D1110 |
Prophylaxis - adult |
237 |
235 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
404 |
400 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
905 |
869 |
$5K |
| D2752 |
|
12 |
12 |
$4K |
| D1206 |
Topical application of fluoride varnish |
32 |
32 |
$848.90 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$332.74 |
| D0230 |
Intraoral - periapical each additional radiographic image |
58 |
55 |
$300.17 |