| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,047 |
988 |
$27K |
| D1120 |
Prophylaxis - child |
650 |
608 |
$21K |
| D1110 |
Prophylaxis - adult |
374 |
357 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,229 |
1,154 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,130 |
1,065 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,073 |
1,002 |
$11K |
| D0272 |
Bitewings - two radiographic images |
326 |
302 |
$7K |
| D0274 |
Bitewings - four radiographic images |
207 |
201 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
44 |
37 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
38 |
$1K |
| D0602 |
|
320 |
307 |
$0.00 |
| D0603 |
|
102 |
97 |
$0.00 |
| D0601 |
|
657 |
617 |
$0.00 |