| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,983 |
1,754 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
1,514 |
1,345 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,806 |
1,609 |
$44K |
| D0274 |
Bitewings - four radiographic images |
259 |
233 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
435 |
375 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
242 |
205 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
47 |
41 |
$2K |
| D0330 |
Panoramic radiographic image |
23 |
19 |
$1K |