| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,309 |
1,039 |
$41K |
| D1120 |
Prophylaxis - child |
1,411 |
1,213 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,267 |
1,113 |
$28K |
| D0330 |
Panoramic radiographic image |
500 |
371 |
$20K |
| D1351 |
Sealant - per tooth |
723 |
94 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
237 |
217 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
465 |
365 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,188 |
938 |
$12K |
| D0274 |
Bitewings - four radiographic images |
414 |
346 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
354 |
325 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
611 |
392 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
72 |
56 |
$938.23 |