| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,206 |
1,732 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,948 |
1,495 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,001 |
928 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
682 |
540 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
849 |
478 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
510 |
413 |
$6K |
| D0272 |
Bitewings - two radiographic images |
495 |
242 |
$4K |
| D0274 |
Bitewings - four radiographic images |
93 |
90 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
36 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
32 |
32 |
$541.02 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
13 |
$236.70 |
| D1999 |
|
21 |
20 |
$0.00 |