| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,074 |
2,067 |
$118K |
| D1110 |
Prophylaxis - adult |
1,333 |
1,328 |
$115K |
| D1120 |
Prophylaxis - child |
1,019 |
1,017 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,645 |
2,636 |
$34K |
| D0274 |
Bitewings - four radiographic images |
941 |
935 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
214 |
214 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
263 |
263 |
$12K |
| D0350 |
|
801 |
524 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
254 |
239 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
589 |
278 |
$2K |