| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
764 |
754 |
$19K |
| D1110 |
Prophylaxis - adult |
442 |
428 |
$18K |
| D1206 |
Topical application of fluoride varnish |
478 |
467 |
$12K |
| D1120 |
Prophylaxis - child |
262 |
256 |
$11K |
| D0330 |
Panoramic radiographic image |
192 |
188 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
307 |
285 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
68 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
184 |
175 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
33 |
33 |
$759.00 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$704.00 |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$546.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
26 |
$388.00 |