| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,777 |
3,684 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
5,411 |
5,248 |
$147K |
| D1120 |
Prophylaxis - child |
1,354 |
1,291 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,204 |
1,148 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
794 |
773 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
369 |
338 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,242 |
1,185 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,065 |
1,002 |
$5K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$122.20 |