| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
125 |
122 |
$3K |
| D1110 |
Prophylaxis - adult |
113 |
106 |
$3K |
| D1120 |
Prophylaxis - child |
145 |
139 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
150 |
141 |
$2K |
| D0274 |
Bitewings - four radiographic images |
81 |
79 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
73 |
69 |
$1K |
| D1206 |
Topical application of fluoride varnish |
65 |
64 |
$915.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$780.00 |
| D0272 |
Bitewings - two radiographic images |
47 |
45 |
$450.00 |