| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,027 |
929 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,140 |
1,022 |
$24K |
| D1110 |
Prophylaxis - adult |
403 |
373 |
$23K |
| D1120 |
Prophylaxis - child |
545 |
479 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
442 |
406 |
$16K |
| D0272 |
Bitewings - two radiographic images |
145 |
130 |
$3K |
| D0274 |
Bitewings - four radiographic images |
76 |
68 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32 |
30 |
$967.00 |
| D0220 |
Intraoral - periapical first radiographic image |
54 |
50 |
$841.50 |
| D0330 |
Panoramic radiographic image |
15 |
13 |
$810.70 |