| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
914 |
910 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
468 |
466 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,479 |
1,204 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
258 |
256 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
127 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
174 |
173 |
$4K |
| D0330 |
Panoramic radiographic image |
56 |
56 |
$2K |
| D0274 |
Bitewings - four radiographic images |
166 |
165 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
39 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
207 |
203 |
$1K |