| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,717 |
1,624 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,138 |
2,013 |
$42K |
| D0274 |
Bitewings - four radiographic images |
644 |
606 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,021 |
938 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
244 |
227 |
$7K |
| D1120 |
Prophylaxis - child |
243 |
211 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
53 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$511.20 |
| D0272 |
Bitewings - two radiographic images |
28 |
26 |
$347.34 |