| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,078 |
6,013 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
5,463 |
5,402 |
$146K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,307 |
5,236 |
$103K |
| D1110 |
Prophylaxis - adult |
1,058 |
1,049 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,020 |
990 |
$44K |
| D0145 |
Oral evaluation for a patient under three years of age |
772 |
768 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,568 |
1,555 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,290 |
1,287 |
$31K |
| D0330 |
Panoramic radiographic image |
42 |
40 |
$2K |