| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
642 |
592 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
784 |
705 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
642 |
592 |
$15K |
| D0274 |
Bitewings - four radiographic images |
453 |
406 |
$14K |
| D0330 |
Panoramic radiographic image |
128 |
127 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
637 |
442 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
552 |
490 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
116 |
100 |
$3K |
| D1110 |
Prophylaxis - adult |
126 |
97 |
$2K |