| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,915 |
1,912 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
1,473 |
1,471 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,111 |
1,110 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
328 |
328 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,135 |
1,130 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
927 |
923 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
318 |
318 |
$7K |
| D1320 |
|
915 |
914 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
316 |
316 |
$3K |
| D1999 |
|
37 |
37 |
$0.00 |