| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
85 |
77 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
81 |
73 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
62 |
56 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
60 |
55 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
21 |
18 |
$481.60 |
| D0274 |
Bitewings - four radiographic images |
31 |
28 |
$405.60 |
| D0220 |
Intraoral - periapical first radiographic image |
69 |
64 |
$341.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
52 |
47 |
$171.00 |
| D0272 |
Bitewings - two radiographic images |
16 |
15 |
$131.60 |