| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
434 |
432 |
$41K |
| D1120 |
Prophylaxis - child |
745 |
732 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
836 |
821 |
$34K |
| D1206 |
Topical application of fluoride varnish |
825 |
815 |
$33K |
| D0272 |
Bitewings - two radiographic images |
649 |
645 |
$25K |
| D1110 |
Prophylaxis - adult |
233 |
231 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
190 |
$15K |
| D0274 |
Bitewings - four radiographic images |
268 |
262 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
119 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
345 |
334 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
114 |
113 |
$4K |
| D1351 |
Sealant - per tooth |
75 |
25 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
84 |
$3K |