| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
342 |
300 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
395 |
334 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
588 |
515 |
$6K |
| D1110 |
Prophylaxis - adult |
75 |
61 |
$3K |
| D0274 |
Bitewings - four radiographic images |
41 |
39 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
28 |
$946.58 |
| D0230 |
Intraoral - periapical each additional radiographic image |
112 |
73 |
$832.18 |
| D0220 |
Intraoral - periapical first radiographic image |
106 |
93 |
$798.80 |
| D0272 |
Bitewings - two radiographic images |
48 |
41 |
$671.00 |
| D0330 |
Panoramic radiographic image |
15 |
12 |
$236.30 |
| D0602 |
|
101 |
95 |
$0.00 |
| D0601 |
|
298 |
288 |
$0.00 |
| D0603 |
|
158 |
132 |
$0.00 |