| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
722 |
420 |
$24K |
| D0330 |
Panoramic radiographic image |
539 |
301 |
$19K |
| D1999 |
|
1,290 |
790 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
745 |
413 |
$17K |
| D0272 |
Bitewings - two radiographic images |
667 |
369 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
262 |
145 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
252 |
144 |
$2K |
| D1120 |
Prophylaxis - child |
80 |
41 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
171 |
92 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
77 |
67 |
$1K |