| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
751 |
710 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
820 |
793 |
$19K |
| D0272 |
Bitewings - two radiographic images |
619 |
594 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
721 |
682 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
843 |
617 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
208 |
192 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
316 |
292 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$537.44 |
| D1206 |
Topical application of fluoride varnish |
27 |
25 |
$488.75 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$469.30 |