| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,406 |
1,167 |
$34K |
| D0272 |
Bitewings - two radiographic images |
978 |
810 |
$20K |
| D1110 |
Prophylaxis - adult |
454 |
371 |
$19K |
| D1120 |
Prophylaxis - child |
565 |
456 |
$18K |
| D1206 |
Topical application of fluoride varnish |
570 |
461 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
86 |
84 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
248 |
216 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
65 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
89 |
68 |
$1K |
| D0330 |
Panoramic radiographic image |
20 |
17 |
$250.80 |