| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
831 |
786 |
$45K |
| D1120 |
Prophylaxis - child |
953 |
923 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,246 |
1,195 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
810 |
743 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,018 |
1,902 |
$22K |
| D0274 |
Bitewings - four radiographic images |
939 |
916 |
$22K |
| D1206 |
Topical application of fluoride varnish |
579 |
571 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
672 |
642 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,718 |
1,423 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
320 |
299 |
$3K |
| D1110 |
Prophylaxis - adult |
27 |
25 |
$529.81 |