| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
255 |
236 |
$12K |
| D1110 |
Prophylaxis - adult |
172 |
155 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
322 |
296 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
284 |
252 |
$5K |
| D1120 |
Prophylaxis - child |
180 |
166 |
$5K |
| D1351 |
Sealant - per tooth |
121 |
13 |
$4K |
| D0272 |
Bitewings - two radiographic images |
169 |
154 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
68 |
$3K |
| D0274 |
Bitewings - four radiographic images |
26 |
25 |
$773.30 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$132.00 |