| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,356 |
1,094 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
812 |
626 |
$23K |
| D0330 |
Panoramic radiographic image |
459 |
332 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
381 |
318 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
460 |
386 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
809 |
626 |
$10K |
| D1206 |
Topical application of fluoride varnish |
192 |
176 |
$4K |
| D0272 |
Bitewings - two radiographic images |
59 |
52 |
$1K |