| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,866 |
1,773 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
2,090 |
1,986 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,851 |
1,761 |
$36K |
| D0272 |
Bitewings - two radiographic images |
530 |
502 |
$15K |
| D0274 |
Bitewings - four radiographic images |
78 |
77 |
$3K |
| D1110 |
Prophylaxis - adult |
42 |
42 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
29 |
28 |
$780.82 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
15 |
$286.78 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$193.36 |