| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
992 |
962 |
$27K |
| D1110 |
Prophylaxis - adult |
387 |
370 |
$20K |
| D1120 |
Prophylaxis - child |
458 |
450 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
990 |
965 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
927 |
890 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
850 |
809 |
$9K |
| D0274 |
Bitewings - four radiographic images |
271 |
255 |
$9K |
| D0272 |
Bitewings - two radiographic images |
167 |
163 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
16 |
$565.12 |
| D0602 |
|
339 |
333 |
$0.00 |
| D0603 |
|
611 |
595 |
$0.00 |