| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
575 |
567 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,041 |
1,133 |
$17K |
| D1110 |
Prophylaxis - adult |
190 |
186 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,054 |
1,042 |
$13K |
| D1120 |
Prophylaxis - child |
239 |
237 |
$8K |
| D9110 |
|
112 |
109 |
$7K |
| D0274 |
Bitewings - four radiographic images |
311 |
311 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
391 |
378 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
48 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
42 |
$2K |