| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,182 |
1,177 |
$140K |
| D0272 |
Bitewings - two radiographic images |
421 |
418 |
$27K |
| D1120 |
Prophylaxis - child |
1,330 |
1,326 |
$15K |
| D1206 |
Topical application of fluoride varnish |
1,440 |
1,435 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$4K |
| D0274 |
Bitewings - four radiographic images |
237 |
236 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
308 |
307 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
76 |
$21.70 |
| D0330 |
Panoramic radiographic image |
30 |
30 |
$0.00 |