| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,007 |
1,708 |
$54K |
| D1110 |
Prophylaxis - adult |
1,310 |
1,269 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,165 |
1,138 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,405 |
1,377 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,918 |
1,789 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,748 |
1,500 |
$18K |
| D1206 |
Topical application of fluoride varnish |
519 |
508 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
162 |
153 |
$6K |
| D1120 |
Prophylaxis - child |
24 |
24 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$284.20 |