| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
919 |
874 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
987 |
941 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,037 |
985 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
462 |
147 |
$4K |
| D1110 |
Prophylaxis - adult |
66 |
64 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
175 |
169 |
$2K |
| D0272 |
Bitewings - two radiographic images |
94 |
92 |
$1K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$825.30 |
| D0274 |
Bitewings - four radiographic images |
13 |
12 |
$197.98 |