| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
506 |
473 |
$14K |
| D1110 |
Prophylaxis - adult |
242 |
228 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
101 |
$4K |
| D1120 |
Prophylaxis - child |
93 |
89 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
23 |
$2K |
| D0274 |
Bitewings - four radiographic images |
27 |
25 |
$820.50 |
| D1206 |
Topical application of fluoride varnish |
13 |
12 |
$272.76 |
| D1208 |
Topical application of fluoride, excluding varnish |
22 |
14 |
$185.60 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$84.00 |