| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,197 |
1,171 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,312 |
1,279 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
390 |
384 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
130 |
125 |
$6K |
| D0274 |
Bitewings - four radiographic images |
217 |
215 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
146 |
140 |
$3K |
| D1120 |
Prophylaxis - child |
81 |
81 |
$3K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$415.56 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$208.00 |