| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,354 |
3,234 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
3,184 |
3,097 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,039 |
1,013 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,977 |
1,855 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
782 |
766 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,330 |
1,239 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
302 |
294 |
$12K |
| D1120 |
Prophylaxis - child |
234 |
233 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
207 |
190 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
78 |
75 |
$6K |