| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,506 |
1,489 |
$43K |
| D1120 |
Prophylaxis - child |
886 |
880 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
854 |
843 |
$17K |
| D1110 |
Prophylaxis - adult |
236 |
233 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
52 |
$3K |
| D0272 |
Bitewings - two radiographic images |
84 |
84 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
104 |
103 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$578.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
12 |
$257.91 |