| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,039 |
1,922 |
$54K |
| D1120 |
Prophylaxis - child |
1,310 |
1,258 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,295 |
1,249 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,109 |
1,066 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,279 |
2,164 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,229 |
2,051 |
$11K |
| D1110 |
Prophylaxis - adult |
264 |
255 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
216 |
203 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
84 |
80 |
$1K |