| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
433 |
401 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
635 |
592 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
232 |
214 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
207 |
65 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
109 |
95 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
48 |
$1K |
| D0272 |
Bitewings - two radiographic images |
41 |
38 |
$780.05 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
24 |
$177.50 |