| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
695 |
685 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
553 |
547 |
$7K |
| D1120 |
Prophylaxis - child |
391 |
386 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
374 |
368 |
$4K |
| D1110 |
Prophylaxis - adult |
332 |
329 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
255 |
252 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
525 |
515 |
$1K |
| D0274 |
Bitewings - four radiographic images |
158 |
156 |
$642.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
430 |
425 |
$329.70 |
| D0140 |
Limited oral evaluation - problem focused |
54 |
54 |
$138.60 |