| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,227 |
3,879 |
$109K |
| D1110 |
Prophylaxis - adult |
2,054 |
1,869 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,285 |
3,916 |
$83K |
| D0272 |
Bitewings - two radiographic images |
3,386 |
3,123 |
$78K |
| D1120 |
Prophylaxis - child |
2,200 |
2,016 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
3,133 |
2,839 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,806 |
2,565 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
259 |
226 |
$19K |
| D0601 |
|
1,396 |
1,299 |
$7K |
| D0602 |
|
492 |
458 |
$2K |
| D2140 |
|
19 |
12 |
$1K |
| D0240 |
|
26 |
13 |
$632.20 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$410.40 |
| D0603 |
|
27 |
27 |
$130.00 |