| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,541 |
2,308 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
2,483 |
2,280 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,628 |
1,474 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
724 |
644 |
$25K |
| D0330 |
Panoramic radiographic image |
136 |
110 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
364 |
326 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
83 |
76 |
$3K |
| D1206 |
Topical application of fluoride varnish |
148 |
143 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
48 |
$3K |
| D1120 |
Prophylaxis - child |
28 |
26 |
$621.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
39 |
37 |
$514.97 |