| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,248 |
935 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
552 |
490 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
522 |
437 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
360 |
167 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
440 |
347 |
$4K |
| D1206 |
Topical application of fluoride varnish |
414 |
236 |
$4K |
| D0274 |
Bitewings - four radiographic images |
158 |
118 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
339 |
282 |
$3K |