| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
169 |
165 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
184 |
181 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
215 |
211 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
155 |
151 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
165 |
148 |
$2K |
| D0272 |
Bitewings - two radiographic images |
71 |
70 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
51 |
$1K |
| D0274 |
Bitewings - four radiographic images |
38 |
38 |
$1K |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$875.35 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$811.89 |