| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
472 |
459 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
490 |
475 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
297 |
152 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
208 |
199 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
66 |
$3K |
| D1120 |
Prophylaxis - child |
53 |
50 |
$2K |
| D0274 |
Bitewings - four radiographic images |
49 |
49 |
$2K |
| D1206 |
Topical application of fluoride varnish |
38 |
38 |
$936.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
13 |
$403.00 |