| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,788 |
1,722 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,712 |
1,648 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,346 |
1,310 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
247 |
222 |
$5K |
| D0274 |
Bitewings - four radiographic images |
208 |
200 |
$3K |
| D0330 |
Panoramic radiographic image |
66 |
65 |
$1K |
| D1206 |
Topical application of fluoride varnish |
16 |
15 |
$312.00 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$209.10 |
| D0272 |
Bitewings - two radiographic images |
29 |
28 |
$204.80 |