| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
246 |
229 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
101 |
95 |
$4K |
| D1110 |
Prophylaxis - adult |
70 |
63 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
60 |
56 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
65 |
63 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
27 |
$287.40 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$237.60 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$132.50 |
| D1208 |
Topical application of fluoride, excluding varnish |
20 |
13 |
$84.00 |