| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
932 |
884 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
743 |
681 |
$10K |
| D4910 |
|
183 |
180 |
$9K |
| D1110 |
Prophylaxis - adult |
200 |
188 |
$6K |
| D2740 |
Crown - porcelain/ceramic |
13 |
12 |
$5K |
| D0180 |
|
113 |
109 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
250 |
216 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
48 |
45 |
$2K |
| D4341 |
|
38 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
52 |
50 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
45 |
43 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
69 |
63 |
$756.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
58 |
29 |
$279.00 |