| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,035 |
1,950 |
$37K |
| D1120 |
Prophylaxis - child |
1,153 |
1,104 |
$31K |
| D1110 |
Prophylaxis - adult |
833 |
810 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,970 |
1,890 |
$28K |
| D1999 |
|
1,534 |
1,290 |
$26K |
| D0274 |
Bitewings - four radiographic images |
616 |
593 |
$14K |
| D0330 |
Panoramic radiographic image |
274 |
269 |
$13K |
| D0272 |
Bitewings - two radiographic images |
678 |
648 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
60 |
$1K |
| D9110 |
|
15 |
13 |
$520.00 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
13 |
$99.00 |