| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
863 |
829 |
$24K |
| D1120 |
Prophylaxis - child |
583 |
559 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,043 |
1,000 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,069 |
1,021 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,127 |
977 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
55 |
53 |
$8K |
| D1110 |
Prophylaxis - adult |
118 |
116 |
$6K |
| D0272 |
Bitewings - two radiographic images |
231 |
221 |
$5K |
| D0274 |
Bitewings - four radiographic images |
105 |
103 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$423.84 |
| D0601 |
|
534 |
512 |
$0.00 |
| D0603 |
|
106 |
93 |
$0.00 |
| D0602 |
|
195 |
185 |
$0.00 |