| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,253 |
1,964 |
$35K |
| D1120 |
Prophylaxis - child |
1,127 |
1,003 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,126 |
1,874 |
$27K |
| D1354 |
|
861 |
197 |
$21K |
| D1110 |
Prophylaxis - adult |
414 |
344 |
$11K |
| D1999 |
|
696 |
565 |
$11K |
| D0330 |
Panoramic radiographic image |
125 |
110 |
$5K |
| D0272 |
Bitewings - two radiographic images |
232 |
201 |
$3K |
| D0274 |
Bitewings - four radiographic images |
47 |
42 |
$880.40 |
| D0220 |
Intraoral - periapical first radiographic image |
51 |
47 |
$466.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
12 |
$140.00 |