| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
345 |
336 |
$8K |
| D1110 |
Prophylaxis - adult |
207 |
197 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
128 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
314 |
294 |
$4K |
| D1120 |
Prophylaxis - child |
74 |
74 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
367 |
262 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
61 |
60 |
$2K |
| D1206 |
Topical application of fluoride varnish |
59 |
59 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
27 |
$1K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$372.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$363.23 |