| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
601 |
587 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
781 |
772 |
$14K |
| D1206 |
Topical application of fluoride varnish |
386 |
382 |
$6K |
| D0274 |
Bitewings - four radiographic images |
240 |
236 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
156 |
147 |
$4K |
| D1120 |
Prophylaxis - child |
130 |
125 |
$4K |
| D0330 |
Panoramic radiographic image |
133 |
128 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
38 |
$964.75 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
14 |
$688.19 |
| D0272 |
Bitewings - two radiographic images |
27 |
26 |
$429.92 |