| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
748 |
723 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
375 |
353 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
1,037 |
986 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
404 |
391 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
645 |
607 |
$12K |
| D1206 |
Topical application of fluoride varnish |
340 |
333 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
204 |
186 |
$3K |
| D0330 |
Panoramic radiographic image |
55 |
55 |
$3K |
| D0272 |
Bitewings - two radiographic images |
163 |
155 |
$3K |
| D9420 |
|
14 |
12 |
$743.26 |
| D1110 |
Prophylaxis - adult |
16 |
16 |
$720.15 |