| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
532 |
513 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
462 |
446 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
316 |
307 |
$8K |
| D0274 |
Bitewings - four radiographic images |
141 |
135 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
245 |
237 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
211 |
202 |
$748.40 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21 |
19 |
$399.95 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$223.70 |