| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,400 |
1,359 |
$33K |
| D1110 |
Prophylaxis - adult |
750 |
728 |
$26K |
| D0274 |
Bitewings - four radiographic images |
257 |
251 |
$8K |
| D0272 |
Bitewings - two radiographic images |
381 |
370 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
226 |
221 |
$7K |
| D1120 |
Prophylaxis - child |
137 |
136 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
481 |
463 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
121 |
120 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30 |
14 |
$315.01 |