| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,425 |
1,373 |
$37K |
| D1120 |
Prophylaxis - child |
690 |
682 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,282 |
1,224 |
$29K |
| D0274 |
Bitewings - four radiographic images |
552 |
544 |
$20K |
| D1110 |
Prophylaxis - adult |
357 |
348 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
731 |
372 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
426 |
383 |
$5K |
| D0330 |
Panoramic radiographic image |
43 |
43 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
64 |
63 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
39 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$407.68 |
| D0603 |
|
21 |
21 |
$0.00 |