| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
657 |
609 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
674 |
626 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
345 |
305 |
$15K |
| D1120 |
Prophylaxis - child |
359 |
330 |
$12K |
| D0274 |
Bitewings - four radiographic images |
231 |
196 |
$6K |
| D1206 |
Topical application of fluoride varnish |
260 |
245 |
$5K |
| D0330 |
Panoramic radiographic image |
33 |
32 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
130 |
108 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
25 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$879.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$113.40 |