| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,125 |
4,056 |
$101K |
| D1110 |
Prophylaxis - adult |
2,121 |
2,084 |
$100K |
| D1120 |
Prophylaxis - child |
1,847 |
1,816 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,074 |
3,011 |
$40K |
| D0274 |
Bitewings - four radiographic images |
710 |
697 |
$22K |
| D0272 |
Bitewings - two radiographic images |
529 |
524 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
686 |
668 |
$9K |
| D0330 |
Panoramic radiographic image |
164 |
164 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
569 |
555 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
97 |
97 |
$4K |
| D1206 |
Topical application of fluoride varnish |
57 |
57 |
$943.07 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$430.02 |