| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
550 |
455 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
734 |
619 |
$18K |
| D0272 |
Bitewings - two radiographic images |
580 |
494 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
521 |
434 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
503 |
392 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
365 |
278 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$478.80 |
| D1120 |
Prophylaxis - child |
16 |
15 |
$399.81 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$62.70 |