| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
303 |
288 |
$6K |
| D0272 |
Bitewings - two radiographic images |
220 |
202 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
282 |
263 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
140 |
132 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
126 |
124 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
121 |
$1K |
| D0330 |
Panoramic radiographic image |
44 |
44 |
$1K |
| D1120 |
Prophylaxis - child |
59 |
57 |
$874.80 |
| D2140 |
|
30 |
16 |
$646.00 |
| D0220 |
Intraoral - periapical first radiographic image |
40 |
38 |
$182.55 |