| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
250 |
248 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
591 |
578 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
747 |
516 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
270 |
265 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
591 |
575 |
$7K |
| D0274 |
Bitewings - four radiographic images |
75 |
73 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58 |
57 |
$2K |
| D0272 |
Bitewings - two radiographic images |
51 |
51 |
$1K |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$637.71 |
| D0601 |
|
301 |
299 |
$0.00 |
| D0603 |
|
18 |
16 |
$0.00 |