| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,240 |
1,204 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,799 |
1,752 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,243 |
1,206 |
$30K |
| D1110 |
Prophylaxis - adult |
361 |
342 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
516 |
501 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
634 |
597 |
$11K |
| D0274 |
Bitewings - four radiographic images |
269 |
254 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
515 |
420 |
$7K |
| D0330 |
Panoramic radiographic image |
30 |
24 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$587.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
13 |
$360.00 |
| D1999 |
|
458 |
398 |
$0.00 |