| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,519 |
1,473 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,079 |
2,019 |
$44K |
| D0274 |
Bitewings - four radiographic images |
613 |
588 |
$20K |
| D1120 |
Prophylaxis - child |
415 |
404 |
$12K |
| D1206 |
Topical application of fluoride varnish |
394 |
384 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
189 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
214 |
210 |
$1K |
| D0272 |
Bitewings - two radiographic images |
44 |
42 |
$744.30 |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$129.04 |