| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
598 |
591 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
552 |
546 |
$13K |
| D0274 |
Bitewings - four radiographic images |
206 |
200 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
133 |
130 |
$4K |
| D0330 |
Panoramic radiographic image |
51 |
50 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
180 |
176 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
50 |
50 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
119 |
117 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
94 |
41 |
$1K |
| D1120 |
Prophylaxis - child |
15 |
14 |
$310.44 |