| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
246 |
231 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
508 |
478 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
815 |
689 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
312 |
300 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
382 |
319 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
53 |
$722.11 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$353.95 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
14 |
$249.92 |