| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
488 |
379 |
$16K |
| D1206 |
Topical application of fluoride varnish |
483 |
372 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
241 |
206 |
$6K |
| D0274 |
Bitewings - four radiographic images |
255 |
197 |
$4K |
| D0350 |
|
719 |
335 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
443 |
342 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
421 |
326 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
116 |
74 |
$1K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$1K |
| D0603 |
|
277 |
246 |
$1K |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$288.00 |
| D0602 |
|
14 |
12 |
$35.00 |