| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
315 |
302 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
602 |
585 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
344 |
338 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
117 |
107 |
$3K |
| D1120 |
Prophylaxis - child |
140 |
134 |
$3K |
| D0330 |
Panoramic radiographic image |
60 |
58 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
24 |
$653.71 |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$430.50 |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
62 |
$329.00 |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$327.00 |