| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,002 |
981 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
675 |
662 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
591 |
576 |
$17K |
| D0274 |
Bitewings - four radiographic images |
286 |
281 |
$11K |
| D1120 |
Prophylaxis - child |
218 |
215 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
549 |
522 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
359 |
286 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
52 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
68 |
67 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
13 |
$449.00 |