| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,146 |
1,002 |
$34K |
| D1999 |
|
1,795 |
1,465 |
$24K |
| D0272 |
Bitewings - two radiographic images |
470 |
447 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
349 |
299 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
194 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
110 |
106 |
$858.88 |
| D0230 |
Intraoral - periapical each additional radiographic image |
93 |
56 |
$700.28 |
| D1208 |
Topical application of fluoride, excluding varnish |
34 |
26 |
$489.39 |
| D0140 |
Limited oral evaluation - problem focused |
29 |
26 |
$459.27 |