| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,006 |
2,006 |
$53K |
| D1120 |
Prophylaxis - child |
2,154 |
2,153 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,671 |
2,670 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
927 |
926 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,965 |
1,322 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,530 |
1,527 |
$16K |
| D1110 |
Prophylaxis - adult |
491 |
491 |
$15K |
| D0272 |
Bitewings - two radiographic images |
729 |
729 |
$12K |
| D0274 |
Bitewings - four radiographic images |
290 |
290 |
$6K |
| D0330 |
Panoramic radiographic image |
153 |
153 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
107 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$426.00 |