| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
643 |
585 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
590 |
552 |
$20K |
| D1120 |
Prophylaxis - child |
569 |
524 |
$14K |
| D0330 |
Panoramic radiographic image |
256 |
230 |
$10K |
| D8670 |
Periodic orthodontic treatment visit |
116 |
94 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
374 |
347 |
$6K |
| D0272 |
Bitewings - two radiographic images |
255 |
227 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
45 |
40 |
$504.96 |
| D0120 |
Periodic oral evaluation - established patient |
25 |
17 |
$462.00 |