| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
698 |
662 |
$14K |
| D1110 |
Prophylaxis - adult |
495 |
464 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,167 |
1,089 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
635 |
598 |
$10K |
| D1120 |
Prophylaxis - child |
391 |
372 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
989 |
910 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
301 |
286 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
395 |
373 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
201 |
192 |
$5K |
| D1351 |
Sealant - per tooth |
44 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
30 |
28 |
$486.41 |