| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
780 |
769 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
846 |
834 |
$14K |
| D1206 |
Topical application of fluoride varnish |
414 |
411 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
378 |
374 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
115 |
$3K |
| D1120 |
Prophylaxis - child |
108 |
108 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
64 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$1K |
| D0274 |
Bitewings - four radiographic images |
51 |
50 |
$935.02 |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
53 |
$513.40 |