| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
631 |
619 |
$16K |
| D1120 |
Prophylaxis - child |
360 |
353 |
$12K |
| D0274 |
Bitewings - four radiographic images |
444 |
433 |
$10K |
| D1110 |
Prophylaxis - adult |
173 |
170 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,490 |
689 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
775 |
759 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
424 |
414 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
44 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
106 |
105 |
$3K |
| D0272 |
Bitewings - two radiographic images |
123 |
121 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
42 |
$2K |
| D0330 |
Panoramic radiographic image |
30 |
30 |
$864.12 |
| D0601 |
|
941 |
923 |
$0.00 |