| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,064 |
832 |
$21K |
| D1120 |
Prophylaxis - child |
418 |
312 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
343 |
292 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,024 |
945 |
$5K |
| D0274 |
Bitewings - four radiographic images |
579 |
471 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
57 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
15 |
$2K |
| D1110 |
Prophylaxis - adult |
24 |
24 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
131 |
129 |
$669.00 |
| D1206 |
Topical application of fluoride varnish |
33 |
21 |
$260.00 |
| D0272 |
Bitewings - two radiographic images |
94 |
67 |
$221.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$210.00 |