| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,253 |
1,249 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
699 |
697 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
560 |
558 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
243 |
241 |
$23K |
| D0272 |
Bitewings - two radiographic images |
728 |
727 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
268 |
262 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
264 |
259 |
$4K |
| D1120 |
Prophylaxis - child |
55 |
55 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
67 |
67 |
$920.00 |
| D1999 |
|
670 |
560 |
$0.00 |