| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,790 |
1,778 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
1,818 |
1,808 |
$42K |
| D0272 |
Bitewings - two radiographic images |
961 |
960 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
186 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
150 |
150 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
45 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
79 |
76 |
$1K |
| D1120 |
Prophylaxis - child |
15 |
15 |
$765.00 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$556.00 |
| D1999 |
|
214 |
199 |
$0.00 |