| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,307 |
3,304 |
$67K |
| D1110 |
Prophylaxis - adult |
1,818 |
1,815 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,504 |
3,324 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,623 |
1,622 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
3,303 |
3,301 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
2,903 |
2,895 |
$23K |
| D1120 |
Prophylaxis - child |
448 |
448 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
564 |
564 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
201 |
201 |
$4K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$152.91 |