| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,291 |
1,242 |
$32K |
| D1110 |
Prophylaxis - adult |
730 |
692 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,206 |
1,153 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,186 |
1,111 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
489 |
443 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,125 |
945 |
$13K |
| D1120 |
Prophylaxis - child |
444 |
434 |
$12K |
| D0274 |
Bitewings - four radiographic images |
258 |
250 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
94 |
88 |
$4K |
| D0330 |
Panoramic radiographic image |
53 |
49 |
$3K |
| D0272 |
Bitewings - two radiographic images |
40 |
40 |
$765.49 |