| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,130 |
2,078 |
$91K |
| D9944 |
|
181 |
179 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,116 |
2,063 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,739 |
1,694 |
$55K |
| D0274 |
Bitewings - four radiographic images |
743 |
719 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,708 |
377 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
467 |
420 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
218 |
213 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
550 |
502 |
$9K |
| D1110 |
Prophylaxis - adult |
14 |
12 |
$399.36 |
| D1999 |
|
58 |
53 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
58 |
53 |
$0.00 |