| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
533 |
520 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
493 |
472 |
$19K |
| D0274 |
Bitewings - four radiographic images |
398 |
396 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
632 |
391 |
$17K |
| D1110 |
Prophylaxis - adult |
265 |
261 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
582 |
565 |
$12K |
| D1120 |
Prophylaxis - child |
243 |
234 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
52 |
52 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
78 |
28 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$579.00 |