| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
643 |
636 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
571 |
559 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
528 |
524 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,243 |
1,204 |
$1K |
| D0274 |
Bitewings - four radiographic images |
516 |
510 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,020 |
998 |
$919.74 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
283 |
283 |
$802.10 |
| D1120 |
Prophylaxis - child |
78 |
76 |
$195.00 |
| D1206 |
Topical application of fluoride varnish |
50 |
50 |
$19.50 |
| D0601 |
|
303 |
301 |
$10.00 |
| D0602 |
|
12 |
12 |
$0.00 |