| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,645 |
1,596 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,440 |
1,370 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,991 |
1,955 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
1,355 |
1,331 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
770 |
738 |
$10K |
| D0274 |
Bitewings - four radiographic images |
1,007 |
973 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,424 |
1,351 |
$7K |
| D1120 |
Prophylaxis - child |
394 |
385 |
$6K |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$364.81 |
| D1999 |
|
338 |
307 |
$147.50 |