| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
824 |
772 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,085 |
1,014 |
$24K |
| D0272 |
Bitewings - two radiographic images |
459 |
424 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
251 |
236 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
389 |
344 |
$7K |
| D1206 |
Topical application of fluoride varnish |
320 |
317 |
$7K |
| D1120 |
Prophylaxis - child |
178 |
160 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$545.04 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$177.59 |