| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
640 |
635 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,690 |
722 |
$17K |
| D1110 |
Prophylaxis - adult |
241 |
238 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
753 |
745 |
$11K |
| D1120 |
Prophylaxis - child |
259 |
256 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
798 |
780 |
$9K |
| D0274 |
Bitewings - four radiographic images |
280 |
276 |
$8K |
| D0272 |
Bitewings - two radiographic images |
151 |
150 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$1K |
| D0330 |
Panoramic radiographic image |
76 |
76 |
$642.08 |
| D1330 |
|
154 |
151 |
$36.75 |
| D0602 |
|
380 |
380 |
$0.00 |
| D0603 |
|
112 |
109 |
$0.00 |
| D0601 |
|
70 |
70 |
$0.00 |