| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,037 |
1,033 |
$28K |
| D1110 |
Prophylaxis - adult |
543 |
542 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
819 |
814 |
$15K |
| D0274 |
Bitewings - four radiographic images |
414 |
413 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
545 |
540 |
$7K |
| D4910 |
|
105 |
103 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
530 |
450 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32 |
32 |
$1K |
| D0602 |
|
111 |
110 |
$1K |
| D1120 |
Prophylaxis - child |
24 |
24 |
$909.50 |
| D1999 |
|
106 |
101 |
$735.00 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
13 |
$522.00 |
| D0603 |
|
33 |
33 |
$363.00 |
| D0601 |
|
31 |
31 |
$341.00 |