| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
432 |
418 |
$13K |
| D0274 |
Bitewings - four radiographic images |
290 |
285 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
436 |
430 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
107 |
107 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
203 |
68 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
341 |
308 |
$2K |
| D9920 |
|
94 |
75 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
66 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
72 |
65 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
104 |
70 |
$290.60 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$249.48 |