| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,253 |
2,226 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
1,975 |
1,958 |
$8K |
| D0274 |
Bitewings - four radiographic images |
509 |
501 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
782 |
765 |
$897.00 |
| D0210 |
Intraoral - complete series of radiographic images |
497 |
490 |
$704.00 |
| D0140 |
Limited oral evaluation - problem focused |
150 |
143 |
$338.00 |
| D1120 |
Prophylaxis - child |
58 |
58 |
$143.00 |
| D0220 |
Intraoral - periapical first radiographic image |
97 |
94 |
$56.25 |
| D1208 |
Topical application of fluoride, excluding varnish |
330 |
318 |
$42.00 |