| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,852 |
1,841 |
$159K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,684 |
1,672 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
1,622 |
1,612 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,022 |
1,018 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,861 |
1,850 |
$26K |
| D9430 |
|
720 |
687 |
$23K |
| D1120 |
Prophylaxis - child |
475 |
467 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,090 |
1,732 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
792 |
767 |
$9K |
| D0274 |
Bitewings - four radiographic images |
422 |
421 |
$9K |
| D1206 |
Topical application of fluoride varnish |
441 |
440 |
$5K |