| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,857 |
2,851 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
1,272 |
1,270 |
$44K |
| D0274 |
Bitewings - four radiographic images |
865 |
865 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,293 |
1,281 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
914 |
910 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
144 |
143 |
$6K |
| D1120 |
Prophylaxis - child |
115 |
115 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
84 |
83 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
68 |
$2K |
| D1206 |
Topical application of fluoride varnish |
54 |
54 |
$2K |