| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,088 |
956 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
439 |
408 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
539 |
443 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
597 |
487 |
$6K |
| D1206 |
Topical application of fluoride varnish |
294 |
279 |
$5K |
| D0274 |
Bitewings - four radiographic images |
91 |
90 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
32 |
30 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
69 |
60 |
$770.10 |
| D1999 |
|
15 |
15 |
$0.00 |