| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
641 |
629 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
888 |
874 |
$22K |
| D0272 |
Bitewings - two radiographic images |
615 |
600 |
$12K |
| D1206 |
Topical application of fluoride varnish |
634 |
622 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
273 |
263 |
$4K |
| D1120 |
Prophylaxis - child |
84 |
82 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
133 |
114 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
32 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
48 |
48 |
$905.27 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$840.75 |
| D0274 |
Bitewings - four radiographic images |
19 |
19 |
$419.90 |
| D0603 |
|
73 |
71 |
$290.00 |
| D0602 |
|
73 |
72 |
$286.01 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$188.10 |
| D0601 |
|
12 |
12 |
$60.00 |