| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
699 |
653 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
521 |
471 |
$19K |
| D0274 |
Bitewings - four radiographic images |
356 |
347 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
438 |
432 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
615 |
461 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
271 |
106 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
39 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
13 |
$778.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$348.00 |
| D1999 |
|
27 |
25 |
$0.00 |