| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,724 |
1,665 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
2,183 |
2,115 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,512 |
1,434 |
$33K |
| D0274 |
Bitewings - four radiographic images |
872 |
844 |
$33K |
| D1206 |
Topical application of fluoride varnish |
656 |
641 |
$17K |
| D1120 |
Prophylaxis - child |
186 |
182 |
$7K |
| D0330 |
Panoramic radiographic image |
39 |
38 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
44 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
39 |
$2K |
| D0272 |
Bitewings - two radiographic images |
40 |
40 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
54 |
50 |
$865.88 |
| D1999 |
|
170 |
146 |
$0.00 |