| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,860 |
1,812 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
1,382 |
1,347 |
$30K |
| D0274 |
Bitewings - four radiographic images |
519 |
510 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
193 |
187 |
$7K |
| D9110 |
|
153 |
148 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
83 |
78 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$372.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
13 |
$270.00 |