| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
662 |
364 |
$15K |
| D1110 |
Prophylaxis - adult |
323 |
188 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
481 |
324 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
516 |
273 |
$7K |
| D0272 |
Bitewings - two radiographic images |
321 |
178 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
380 |
183 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$376.20 |