| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
434 |
425 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
642 |
619 |
$17K |
| D0274 |
Bitewings - four radiographic images |
404 |
385 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
916 |
875 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
516 |
505 |
$8K |
| D1120 |
Prophylaxis - child |
125 |
120 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
687 |
551 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
145 |
144 |
$4K |
| D0330 |
Panoramic radiographic image |
90 |
84 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
26 |
$778.80 |