| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
46 |
46 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
388 |
153 |
$4K |
| D1120 |
Prophylaxis - child |
93 |
87 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
93 |
88 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
156 |
148 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
181 |
173 |
$2K |
| D0274 |
Bitewings - four radiographic images |
54 |
52 |
$2K |
| D1110 |
Prophylaxis - adult |
15 |
14 |
$658.56 |
| D0350 |
|
29 |
28 |
$404.36 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$378.88 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$184.46 |
| D0603 |
|
56 |
55 |
$0.00 |
| D0602 |
|
111 |
109 |
$0.00 |