| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,372 |
1,283 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
1,529 |
1,452 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,089 |
1,005 |
$25K |
| D0274 |
Bitewings - four radiographic images |
526 |
497 |
$18K |
| D1120 |
Prophylaxis - child |
430 |
414 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
313 |
310 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
38 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
63 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
24 |
$345.04 |
| D1999 |
|
343 |
294 |
$0.00 |