| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,489 |
1,415 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,260 |
1,193 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,185 |
1,146 |
$32K |
| D0274 |
Bitewings - four radiographic images |
462 |
447 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
158 |
147 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
263 |
251 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
55 |
$902.32 |
| D0272 |
Bitewings - two radiographic images |
60 |
53 |
$590.41 |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
28 |
$139.14 |