| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
486 |
440 |
$18K |
| D1120 |
Prophylaxis - child |
324 |
302 |
$16K |
| D1206 |
Topical application of fluoride varnish |
492 |
467 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
202 |
192 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
161 |
144 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
101 |
92 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
41 |
$2K |
| D1110 |
Prophylaxis - adult |
31 |
25 |
$2K |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$610.61 |
| D0601 |
|
456 |
425 |
$0.00 |