| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
724 |
718 |
$756.37 |
| D1206 |
Topical application of fluoride varnish |
1,517 |
1,500 |
$597.68 |
| D1110 |
Prophylaxis - adult |
819 |
807 |
$489.24 |
| D0220 |
Intraoral - periapical first radiographic image |
1,099 |
1,081 |
$416.94 |
| D0120 |
Periodic oral evaluation - established patient |
1,081 |
1,068 |
$416.36 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,100 |
959 |
$379.86 |
| D0350 |
|
3,275 |
935 |
$344.10 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
321 |
318 |
$278.61 |
| D0330 |
Panoramic radiographic image |
55 |
54 |
$247.60 |
| D1354 |
|
1,076 |
216 |
$199.08 |
| D0274 |
Bitewings - four radiographic images |
442 |
435 |
$171.40 |
| D0272 |
Bitewings - two radiographic images |
99 |
99 |
$143.88 |
| D0140 |
Limited oral evaluation - problem focused |
44 |
43 |
$78.72 |
| D1330 |
|
690 |
679 |
$0.00 |
| D9997 |
|
1,637 |
1,523 |
$0.00 |
| D9920 |
|
1,540 |
1,463 |
$0.00 |