| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
360 |
289 |
$7K |
| D1120 |
Prophylaxis - child |
299 |
235 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
400 |
323 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$3K |
| D0274 |
Bitewings - four radiographic images |
151 |
112 |
$2K |
| D0272 |
Bitewings - two radiographic images |
116 |
97 |
$2K |
| D1110 |
Prophylaxis - adult |
32 |
26 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
170 |
140 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
163 |
135 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
12 |
$247.24 |
| D0603 |
|
401 |
376 |
$0.00 |