| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
948 |
925 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,157 |
1,130 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
352 |
347 |
$8K |
| D0274 |
Bitewings - four radiographic images |
465 |
449 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
733 |
709 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
557 |
520 |
$2K |
| D1120 |
Prophylaxis - child |
51 |
49 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
32 |
31 |
$612.20 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$407.50 |