| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,346 |
1,205 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,129 |
1,027 |
$22K |
| D0274 |
Bitewings - four radiographic images |
625 |
537 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
977 |
830 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
105 |
87 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
113 |
99 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
159 |
119 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
27 |
$1K |