| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,893 |
1,756 |
$63K |
| D1120 |
Prophylaxis - child |
1,876 |
1,738 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,112 |
1,086 |
$21K |
| D0330 |
Panoramic radiographic image |
266 |
188 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
451 |
394 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
160 |
148 |
$5K |
| D0272 |
Bitewings - two radiographic images |
333 |
263 |
$5K |
| D1351 |
Sealant - per tooth |
55 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
33 |
27 |
$328.66 |