| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
219 |
218 |
$8K |
| D1110 |
Prophylaxis - adult |
114 |
110 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
436 |
328 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
396 |
386 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
71 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
158 |
149 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
136 |
134 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
39 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
12 |
$0.00 |