| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
713 |
713 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,325 |
1,230 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,101 |
1,101 |
$29K |
| D1120 |
Prophylaxis - child |
677 |
677 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,487 |
1,458 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
644 |
644 |
$16K |
| D0274 |
Bitewings - four radiographic images |
327 |
327 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
100 |
99 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
96 |
94 |
$4K |
| D0272 |
Bitewings - two radiographic images |
88 |
88 |
$2K |