| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
730 |
601 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
458 |
330 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
523 |
417 |
$6K |
| D0274 |
Bitewings - four radiographic images |
234 |
180 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
169 |
150 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
133 |
93 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
385 |
264 |
$3K |
| D0330 |
Panoramic radiographic image |
67 |
62 |
$1K |
| D1110 |
Prophylaxis - adult |
16 |
13 |
$161.62 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$0.00 |