| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
145 |
142 |
$19K |
| D1120 |
Prophylaxis - child |
480 |
443 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
453 |
420 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,162 |
508 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
838 |
783 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
261 |
241 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
600 |
552 |
$7K |
| D0274 |
Bitewings - four radiographic images |
178 |
167 |
$5K |
| D1110 |
Prophylaxis - adult |
89 |
88 |
$5K |
| D0272 |
Bitewings - two radiographic images |
194 |
189 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
68 |
59 |
$4K |
| D0603 |
|
846 |
799 |
$0.26 |
| D0601 |
|
185 |
183 |
$0.00 |
| D1330 |
|
17 |
16 |
$0.00 |
| D0602 |
|
14 |
13 |
$0.00 |