| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
778 |
669 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
616 |
539 |
$16K |
| D0274 |
Bitewings - four radiographic images |
304 |
258 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
182 |
150 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
88 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
74 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
108 |
91 |
$1K |
| D1206 |
Topical application of fluoride varnish |
60 |
59 |
$712.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
51 |
43 |
$559.75 |