| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
1,598 |
1,253 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
807 |
736 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
920 |
805 |
$11K |
| D1110 |
Prophylaxis - adult |
245 |
222 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
553 |
465 |
$5K |
| D1120 |
Prophylaxis - child |
170 |
152 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
89 |
84 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
149 |
76 |
$821.50 |
| D0140 |
Limited oral evaluation - problem focused |
31 |
26 |
$730.80 |
| D0274 |
Bitewings - four radiographic images |
33 |
33 |
$696.00 |
| D0272 |
Bitewings - two radiographic images |
44 |
39 |
$676.80 |
| D1206 |
Topical application of fluoride varnish |
16 |
13 |
$313.20 |