| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
438 |
283 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
411 |
200 |
$8K |
| D0330 |
Panoramic radiographic image |
226 |
178 |
$7K |
| D1120 |
Prophylaxis - child |
370 |
229 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
636 |
398 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
110 |
101 |
$3K |
| D0272 |
Bitewings - two radiographic images |
125 |
54 |
$1K |
| D1206 |
Topical application of fluoride varnish |
27 |
25 |
$657.62 |
| D0220 |
Intraoral - periapical first radiographic image |
68 |
39 |
$427.16 |