| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
588 |
581 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,046 |
1,021 |
$21K |
| D1120 |
Prophylaxis - child |
767 |
759 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,062 |
1,049 |
$21K |
| D0330 |
Panoramic radiographic image |
356 |
356 |
$16K |
| D1206 |
Topical application of fluoride varnish |
653 |
642 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
481 |
471 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
203 |
202 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
98 |
91 |
$3K |