| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
667 |
422 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
305 |
204 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
203 |
167 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
595 |
355 |
$5K |
| D0272 |
Bitewings - two radiographic images |
549 |
310 |
$5K |
| D0330 |
Panoramic radiographic image |
81 |
69 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
41 |
39 |
$967.70 |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
29 |
$357.36 |