| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
485 |
456 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
562 |
524 |
$16K |
| D0274 |
Bitewings - four radiographic images |
166 |
152 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
55 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
124 |
110 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
62 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
31 |
$2K |
| D1120 |
Prophylaxis - child |
28 |
28 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
88 |
73 |
$1K |