| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
716 |
544 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
611 |
511 |
$10K |
| D0274 |
Bitewings - four radiographic images |
431 |
301 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
509 |
394 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
135 |
101 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
174 |
162 |
$2K |
| D1120 |
Prophylaxis - child |
64 |
62 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
265 |
204 |
$1K |
| D1999 |
|
281 |
137 |
$500.00 |
| D1206 |
Topical application of fluoride varnish |
58 |
50 |
$309.00 |