| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,746 |
3,843 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,013 |
2,243 |
$76K |
| D0330 |
Panoramic radiographic image |
2,035 |
1,611 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,716 |
3,806 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,674 |
1,294 |
$54K |
| D0272 |
Bitewings - two radiographic images |
3,812 |
3,048 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,729 |
1,589 |
$44K |
| D1351 |
Sealant - per tooth |
967 |
123 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
266 |
70 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
264 |
248 |
$3K |