| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,195 |
1,105 |
$32K |
| D1999 |
|
1,984 |
1,685 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,729 |
950 |
$22K |
| D0272 |
Bitewings - two radiographic images |
911 |
860 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
751 |
671 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
412 |
401 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,137 |
1,044 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
321 |
290 |
$5K |
| D1120 |
Prophylaxis - child |
100 |
86 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
12 |
$256.68 |