| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,383 |
2,204 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,445 |
2,262 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,335 |
2,160 |
$35K |
| D0330 |
Panoramic radiographic image |
698 |
666 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
700 |
625 |
$26K |
| D0274 |
Bitewings - four radiographic images |
966 |
891 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,151 |
1,926 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,905 |
1,668 |
$14K |
| D0272 |
Bitewings - two radiographic images |
44 |
39 |
$714.61 |