| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,099 |
1,091 |
$31K |
| D1120 |
Prophylaxis - child |
754 |
749 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,880 |
776 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
126 |
122 |
$17K |
| D1110 |
Prophylaxis - adult |
289 |
281 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
917 |
905 |
$13K |
| D0274 |
Bitewings - four radiographic images |
287 |
280 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
863 |
838 |
$9K |
| D0272 |
Bitewings - two radiographic images |
333 |
331 |
$7K |
| D1206 |
Topical application of fluoride varnish |
84 |
84 |
$1K |
| D0603 |
|
1,605 |
1,587 |
$0.00 |