| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
751 |
473 |
$20K |
| D1110 |
Prophylaxis - adult |
375 |
190 |
$14K |
| D1206 |
Topical application of fluoride varnish |
318 |
262 |
$7K |
| D0274 |
Bitewings - four radiographic images |
148 |
97 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
25 |
$2K |
| D1120 |
Prophylaxis - child |
33 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
36 |
31 |
$850.28 |
| D0220 |
Intraoral - periapical first radiographic image |
35 |
25 |
$722.54 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
23 |
12 |
$636.30 |
| D1999 |
|
20 |
18 |
$0.00 |