| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,244 |
171 |
$84K |
| D4910 |
|
808 |
443 |
$33K |
| D9920 |
|
782 |
97 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,412 |
772 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,134 |
619 |
$13K |
| D0272 |
Bitewings - two radiographic images |
576 |
317 |
$4K |
| D4342 |
|
219 |
31 |
$4K |
| D4346 |
|
203 |
100 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
155 |
104 |
$3K |
| D1206 |
Topical application of fluoride varnish |
152 |
89 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
137 |
69 |
$896.70 |
| D0140 |
Limited oral evaluation - problem focused |
37 |
22 |
$48.80 |