| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,024 |
1,586 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,118 |
946 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
979 |
758 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
611 |
554 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
359 |
261 |
$8K |
| D0272 |
Bitewings - two radiographic images |
370 |
287 |
$6K |
| D1206 |
Topical application of fluoride varnish |
159 |
142 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
119 |
73 |
$1K |