| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,634 |
1,600 |
$38K |
| D1120 |
Prophylaxis - child |
729 |
700 |
$32K |
| D0330 |
Panoramic radiographic image |
779 |
757 |
$30K |
| D1351 |
Sealant - per tooth |
1,283 |
126 |
$28K |
| D1206 |
Topical application of fluoride varnish |
714 |
690 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
748 |
718 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
990 |
960 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
203 |
201 |
$6K |
| D1110 |
Prophylaxis - adult |
256 |
245 |
$5K |
| D0350 |
|
244 |
221 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
124 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
213 |
197 |
$1K |
| D0602 |
|
67 |
63 |
$315.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
15 |
$300.00 |
| D9630 |
|
16 |
16 |
$65.00 |