| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
317 |
310 |
$9K |
| D1120 |
Prophylaxis - child |
241 |
232 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
365 |
356 |
$5K |
| D1110 |
Prophylaxis - adult |
103 |
103 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
29 |
$4K |
| D0274 |
Bitewings - four radiographic images |
120 |
119 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
686 |
308 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
230 |
223 |
$3K |
| D0272 |
Bitewings - two radiographic images |
100 |
98 |
$2K |
| D0350 |
|
93 |
90 |
$2K |
| D0601 |
|
347 |
337 |
$0.00 |