| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,414 |
1,343 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,194 |
1,170 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,195 |
1,137 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,291 |
1,177 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
300 |
293 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
173 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
461 |
443 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$370.00 |