| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,703 |
1,581 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,756 |
1,626 |
$37K |
| D0330 |
Panoramic radiographic image |
546 |
509 |
$28K |
| D2394 |
|
192 |
98 |
$23K |
| D0274 |
Bitewings - four radiographic images |
698 |
643 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
829 |
762 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
315 |
295 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
335 |
179 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
232 |
201 |
$2K |
| D1120 |
Prophylaxis - child |
18 |
14 |
$480.24 |
| D1999 |
|
18 |
16 |
$0.00 |