| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
690 |
654 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
776 |
743 |
$18K |
| D0274 |
Bitewings - four radiographic images |
302 |
294 |
$11K |
| D1120 |
Prophylaxis - child |
233 |
222 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
581 |
538 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
392 |
343 |
$5K |
| D1206 |
Topical application of fluoride varnish |
183 |
174 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
131 |
130 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
76 |
68 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
60 |
56 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
30 |
$2K |