| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
850 |
793 |
$14K |
| D1120 |
Prophylaxis - child |
617 |
574 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
550 |
511 |
$12K |
| D0330 |
Panoramic radiographic image |
28 |
27 |
$978.65 |
| D9920 |
|
37 |
37 |
$722.32 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
18 |
$686.46 |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
46 |
$316.80 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$180.36 |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
40 |
$90.06 |