| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
91 |
84 |
$4K |
| D1110 |
Prophylaxis - adult |
44 |
41 |
$4K |
| D0274 |
Bitewings - four radiographic images |
61 |
53 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
47 |
39 |
$2K |
| D1206 |
Topical application of fluoride varnish |
64 |
57 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
62 |
53 |
$2K |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$1K |
| D4910 |
|
14 |
13 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
14 |
$937.72 |
| D1120 |
Prophylaxis - child |
13 |
12 |
$678.70 |