| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,493 |
1,434 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,634 |
1,556 |
$24K |
| D1110 |
Prophylaxis - adult |
682 |
657 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,316 |
1,247 |
$17K |
| D0274 |
Bitewings - four radiographic images |
661 |
619 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
653 |
618 |
$13K |
| D0330 |
Panoramic radiographic image |
366 |
349 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
469 |
444 |
$6K |
| D0272 |
Bitewings - two radiographic images |
265 |
245 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
84 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
192 |
175 |
$2K |
| D7111 |
|
50 |
26 |
$2K |