| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
141 |
76 |
$4K |
| D1120 |
Prophylaxis - child |
322 |
183 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
362 |
205 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
431 |
234 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
546 |
218 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
406 |
225 |
$1K |
| D0272 |
Bitewings - two radiographic images |
64 |
40 |
$350.96 |
| D1110 |
Prophylaxis - adult |
20 |
12 |
$329.28 |
| D0274 |
Bitewings - four radiographic images |
26 |
13 |
$242.21 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
13 |
$158.94 |
| D0603 |
|
109 |
61 |
$0.00 |
| D0602 |
|
354 |
192 |
$0.00 |
| D0601 |
|
23 |
15 |
$0.00 |