| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
727 |
715 |
$18K |
| D1110 |
Prophylaxis - adult |
366 |
359 |
$13K |
| D1120 |
Prophylaxis - child |
391 |
385 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
137 |
136 |
$5K |
| D1206 |
Topical application of fluoride varnish |
347 |
342 |
$5K |
| D0272 |
Bitewings - two radiographic images |
231 |
227 |
$4K |
| D9110 |
|
82 |
81 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
158 |
157 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
75 |
$3K |
| D0274 |
Bitewings - four radiographic images |
14 |
13 |
$454.99 |