| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
426 |
220 |
$213K |
| D1110 |
Prophylaxis - adult |
1,946 |
1,912 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
1,587 |
1,558 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
830 |
811 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
445 |
414 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
264 |
262 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
220 |
219 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
909 |
858 |
$14K |
| D0274 |
Bitewings - four radiographic images |
295 |
293 |
$11K |
| D2950 |
|
259 |
139 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
122 |
122 |
$2K |