| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,786 |
1,753 |
$54K |
| D2750 |
|
48 |
37 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,648 |
1,630 |
$23K |
| D0330 |
Panoramic radiographic image |
539 |
410 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,075 |
928 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
942 |
934 |
$17K |
| D0274 |
Bitewings - four radiographic images |
845 |
833 |
$16K |
| D2950 |
|
150 |
115 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,357 |
1,159 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
157 |
155 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
154 |
139 |
$4K |
| D1120 |
Prophylaxis - child |
49 |
49 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$404.88 |