| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
555 |
499 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
234 |
221 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
342 |
309 |
$2K |
| D1206 |
Topical application of fluoride varnish |
180 |
165 |
$2K |
| D1120 |
Prophylaxis - child |
160 |
153 |
$1K |
| D0274 |
Bitewings - four radiographic images |
34 |
33 |
$863.80 |
| D1110 |
Prophylaxis - adult |
16 |
15 |
$684.88 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19 |
17 |
$547.43 |
| D0272 |
Bitewings - two radiographic images |
89 |
85 |
$278.62 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
12 |
$36.72 |
| D0603 |
|
165 |
161 |
$0.00 |
| D1999 |
|
246 |
225 |
$0.00 |