| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,758 |
1,703 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
1,515 |
1,498 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
897 |
601 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
807 |
802 |
$16K |
| D0274 |
Bitewings - four radiographic images |
577 |
561 |
$14K |
| D1120 |
Prophylaxis - child |
333 |
331 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
408 |
260 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
583 |
373 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
49 |
$3K |
| D0330 |
Panoramic radiographic image |
105 |
53 |
$3K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$249.48 |