| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,177 |
4,079 |
$106K |
| D1120 |
Prophylaxis - child |
4,358 |
4,232 |
$96K |
| D1206 |
Topical application of fluoride varnish |
5,121 |
4,979 |
$82K |
| D0272 |
Bitewings - two radiographic images |
1,523 |
1,481 |
$15K |
| D1999 |
|
1,312 |
1,232 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
154 |
147 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
393 |
381 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
88 |
75 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
129 |
115 |
$282.03 |