| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
793 |
739 |
$18K |
| D0272 |
Bitewings - two radiographic images |
581 |
539 |
$8K |
| D1999 |
|
515 |
491 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
573 |
528 |
$6K |
| D0330 |
Panoramic radiographic image |
193 |
171 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
147 |
134 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
374 |
92 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
66 |
59 |
$1K |
| D1120 |
Prophylaxis - child |
57 |
48 |
$729.00 |
| D0220 |
Intraoral - periapical first radiographic image |
114 |
103 |
$603.99 |