| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,874 |
2,632 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
2,513 |
2,310 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,219 |
2,036 |
$57K |
| D0274 |
Bitewings - four radiographic images |
701 |
641 |
$30K |
| D0272 |
Bitewings - two radiographic images |
564 |
522 |
$16K |
| D0330 |
Panoramic radiographic image |
140 |
125 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
151 |
130 |
$8K |
| D1206 |
Topical application of fluoride varnish |
186 |
176 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
52 |
$3K |
| D1999 |
|
18 |
15 |
$0.00 |