| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
947 |
315 |
$10K |
| D1120 |
Prophylaxis - child |
224 |
213 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
269 |
256 |
$7K |
| D1206 |
Topical application of fluoride varnish |
334 |
321 |
$5K |
| D1110 |
Prophylaxis - adult |
84 |
81 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
353 |
337 |
$4K |
| D0274 |
Bitewings - four radiographic images |
122 |
117 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
28 |
27 |
$621.60 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
13 |
$449.92 |
| D0603 |
|
293 |
281 |
$0.00 |
| D0601 |
|
58 |
58 |
$0.00 |