| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
196 |
182 |
$4K |
| D1120 |
Prophylaxis - child |
196 |
175 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
281 |
258 |
$3K |
| D9920 |
|
69 |
56 |
$2K |
| D1110 |
Prophylaxis - adult |
38 |
36 |
$1K |
| D1351 |
Sealant - per tooth |
98 |
16 |
$1K |
| D0330 |
Panoramic radiographic image |
33 |
29 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
31 |
$941.92 |
| D0274 |
Bitewings - four radiographic images |
52 |
50 |
$649.47 |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
32 |
$251.96 |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
30 |
$147.33 |