| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
866 |
859 |
$21K |
| D1120 |
Prophylaxis - child |
511 |
507 |
$18K |
| D0274 |
Bitewings - four radiographic images |
450 |
448 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
797 |
785 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
172 |
172 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
781 |
683 |
$4K |
| D1110 |
Prophylaxis - adult |
73 |
73 |
$3K |
| D1206 |
Topical application of fluoride varnish |
130 |
128 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
40 |
$1K |