| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
565 |
542 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
384 |
378 |
$9K |
| D0274 |
Bitewings - four radiographic images |
596 |
588 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
399 |
387 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
822 |
795 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
185 |
167 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
711 |
647 |
$3K |
| D1120 |
Prophylaxis - child |
26 |
26 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$222.80 |