| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,121 |
1,074 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,051 |
1,023 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,317 |
1,296 |
$28K |
| D0274 |
Bitewings - four radiographic images |
772 |
739 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
238 |
230 |
$12K |
| D0330 |
Panoramic radiographic image |
264 |
252 |
$11K |
| D1120 |
Prophylaxis - child |
121 |
121 |
$5K |
| D0272 |
Bitewings - two radiographic images |
236 |
236 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
18 |
14 |
$850.68 |
| D1330 |
|
191 |
184 |
$672.00 |
| D0220 |
Intraoral - periapical first radiographic image |
57 |
54 |
$624.49 |