| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
273 |
259 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
404 |
385 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
99 |
93 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
297 |
278 |
$3K |
| D0272 |
Bitewings - two radiographic images |
152 |
141 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
310 |
271 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
76 |
71 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$330.86 |
| D0601 |
|
59 |
59 |
$0.00 |
| D0603 |
|
281 |
274 |
$0.00 |