| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
128 |
123 |
$6K |
| D1206 |
Topical application of fluoride varnish |
144 |
141 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
67 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
125 |
116 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$2K |
| D1120 |
Prophylaxis - child |
30 |
29 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
93 |
43 |
$781.16 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
23 |
$732.12 |
| D0274 |
Bitewings - four radiographic images |
17 |
15 |
$441.54 |
| D1208 |
Topical application of fluoride, excluding varnish |
19 |
17 |
$325.87 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
12 |
$321.23 |
| D0270 |
|
20 |
17 |
$166.50 |