| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
864 |
845 |
$35K |
| D1110 |
Prophylaxis - adult |
386 |
383 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
346 |
342 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
651 |
612 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
797 |
779 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
302 |
301 |
$5K |
| D1120 |
Prophylaxis - child |
129 |
128 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
36 |
36 |
$402.00 |