| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,725 |
1,684 |
$63K |
| D1120 |
Prophylaxis - child |
1,647 |
1,609 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
559 |
544 |
$23K |
| D1206 |
Topical application of fluoride varnish |
935 |
933 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
943 |
906 |
$14K |
| D9999 |
Unspecified adjunctive procedure, by report |
113 |
113 |
$13K |
| D1110 |
Prophylaxis - adult |
206 |
203 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
310 |
302 |
$8K |
| D1310 |
|
88 |
88 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
270 |
170 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
170 |
147 |
$645.92 |
| D0601 |
|
86 |
86 |
$531.61 |
| D1320 |
|
50 |
50 |
$527.76 |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$228.70 |
| D1330 |
|
1,919 |
1,869 |
$0.00 |
| D9993 |
|
27 |
27 |
$0.00 |
| D1999 |
|
12 |
12 |
$0.00 |